Turning the corner on the HIV epidemic in Zimbabwe, Malawi, and Zambia
Newly released findings from national HIV surveys in Zimbabwe, Malawi, and Zambia reveal extraordinary progress in confronting the HIV epidemic. These three countries in Southern Africa have been heavily affected by HIV, and now there are encouraging signs that the epidemics are going in the right direction.
The findings, presented today at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI), are from the PEPFAR-supported Population-based HIV Impact Assessment (PHIA) Project surveys. The surveys are led by each Ministry of Health, with technical assistance from ICAP at Columbia University's Mailman School of Public Health in collaboration with the U.S. Centers for Disease Control and Prevention (CDC). Compared with previous estimates, the PHIA data show that the rate of new infections (incidence) is stabilizing or declining. In addition, more than half of all adults living with HIV, regardless of use of antiretroviral medication, have a suppressed viral load and for those on antiretroviral medication, viral suppression is close to 90 percent. "Taken together, these findings tell a coherent and remarkable story of progress," said Dr. Jessica Justman, principal investigator and associate professor of Epidemiology at the Mailman School of Public Health. "We can see that Zimbabwe, Malawi and Zambia are on track to hit the UNAIDS 90-90-90 targets by 2020."
Understanding the true status of an HIV epidemic rests on accurate measures of HIV prevalence, HIV incidence, and viral load suppression. These critical estimates provide a "report card" on the control of the epidemic and indicate where resources should be channeled to enable continued progress toward the 90-90-90 targets. The PHIA Project provides such information by directly assessing all of these measures through household surveys.
"These results are gratifying evidence that the investment by PEPFAR and other donors, and the efforts of national HIV programs, are paying off. The data from the PHIA surveys provide greater insights on where to focus our collective efforts and resources going forward," said Dr. Shannon Hader, director of the Division of Global HIV and Tuberculosis at CDC.
In Malawi, Zambia, and Zimbabwe, nationally representative groups of adults and children were recruited in each country in 2015-16. Across the three countries, a total of 76,000 adults and children from 34,000 selected households took part in interviews and provided blood samples for testing. Participants received their HIV test result from a trained counselor during the same visit.
Combined HIV prevalence across the three countries was 12.2 percent among adults ages 15-59 years and 1.4 percent among children ages 0-14 years. Combined HIV incidence among adults was 0.51 percent. The combined prevalence of viral suppression (HIV RNA <1000 c/ml) among all HIV-positive adults, irrespective of knowledge of their HIV status, was 61.8 percent. Achievement of the "first 90 target" across the three countries—i.e., prior knowledge of status among those found to be HIV-positive during the survey—was 70 percent; the "second 90 target"—i.e., the percentage of those aware of their HIV-positive status who report current use of antiretroviral therapy (ART)—was 87 percent; and the "third 90 target"—i.e., the percentage among those who report current ART who had HIV viral suppression—was 89 percent. Less progress has been made toward the 90-90-90 targets among adolescents and young adults compared to older adults.
"These results reflect successful HIV care and treatment programs in each country," said Dr. Wafaa El-Sadr, Director of ICAP and University Professor of Epidemiology and Dr. Mathilde Krim-amfAR Chair of Global Health at the Mailman School of Public Health. "Now more than ever, we have to keep our foot on the pedal and push even harder. Targeted testing, especially for adolescents and young adults, and continued expansion of HIV treatment programs and other prevention interventions for all will be critical to achieve ultimate epidemic control."