VMMCInHIVPrevention–PerspectivesfromZimbabweSnapshotoftheHIVEpidemicinZimbabweHIVandAIDSemergedasapublichealththreatinZimbabweinthemid-1980sandremainsoneofthetopheavilyburdenedcountries.InZimbabwetheepidemicislargelydrivenbyunprotectedheterosexualsex,withgrowingepidemicsamongkeypopulationgroupsathigherriskofHIV.KeyEpidemicMetrics(2020)1PeopleLivingwithHIV–1.3millionHIVPrevalence(adults15+)–12.6%

Youngwomenaged15-24–5.6%(youngmen–3.0%)KeyPopulations-disproportionallyhighNewHIVInfections–25,000Youngwomenaged15-24–7,200

Youngmenaged15-24–2,300AIDSrelateddeaths–22,000HIVPrevalencebyProvince21UNAIDSAIDSInfo,20202Zimphia,2020EpidemicProfile|ZimbabwehasreachedepidemiccontrolKeyObservationsThecountryhasanestimated1.3millionpeoplelivingwithHIV(PLHIV),ofwhich60%arefemales,6%arechildrenaged0-14yearsold,and9%areadolescentsandyoungpeopleaged15-24years.KeypopulationsreportedahigherHIVprevalence:sexworkers(42.2%),transgenderpeople(27.5%),andmenwhohavesexwithmen(21%)(UNAIDS,2022)34STIprogrammeEstablishedin1990ThepresenceofanuntreatedSTIincreasestheriskofHIVinfection.IntegrationofroutineSTImanagementwithreportedcasesdecliningby70%in2020.PMTCTprogrammeEstablishedin2002Zimbabwehasachieved99%testingcoverageofallpregnantwomenand93.5%ofHIV-positivepregnantwomenonARTin2019.DailyOralPrEPprogrammeEstablishedin2016HighadherencetodailyoralPrEPreducestheriskofHIVbyover90%.DailyoralPrEPcumulativeinitiationshaveexceeded79,918,asat2022.PEPprogrammeEstablishedin2016PEPistheonlywaytoreducetheriskofHIVinfectioninanindividualwhohasbeenexposedtoHIV.PEPcanreducetheriskofHIVinfectionbyover80%.19901992200220092016CondomsprogrammeEstablishedin1990ConsistentandcorrectuseofcondomscanreduceHIVacquisitionbyupto97%.Uptakeoffemalecondomsremainslowat0.1%.ZimbabweisoneofonlyfivecountriestomeetorexceedUNFPA’sregionalbenchmarkof30condoms/man/year.HTSprogrammeEstablishedin1992HTSistheentrypointtoallHIVpreventionprogrammes.ThereisincreasedacceptanceofHTS,with86.3%ofPLHIVknowingtheirstatusin2020.2015TreatmentprogrammeEstablishedin2004Zimbabweisontracktoreachingthe95-95-95targetby2030,with97.0%ofPLHIVinitiatedonARTandofthoseinitiated90.3%hadsuppressedviralloads.2004OverviewofHIVPreventionInterventionsAvailableinZimbabweVMMCprogrammeEstablishedin2009VMMCreducestheriskforheterosexuallyacquiredHIVinfectionamongmalesby~60%.Impactmodelingconductedin2016showed2,600-12,200infections(amongmenandwomencombined)hadbeenavertedandthiswasexpectedtogrow.2020DapivirineVaginalRing(DVR)MCAZapprovedDVRforwomeninJuly2021,andMOHCCrecommendsthatitshouldbeimplementedunderresearch.TheflexiblesiliconeringslowlyreleasestheARVdrugdapivirineinthevagina,withminimalabsorptionelsewhereinthebody.HIVSTprogrammeEstablishedin201557outof63districtsareimplementingHIVSTasaninnovativeapproachtoexpandthereachofHIVtestingservices.KeyObservationsHighHIVincidencedistricts(southernregion)donothaveanabsoluteburdenofnewinfections.HIVincidencerangedfrom2.55(Mangwe)to0.53(Sanyati).In202315,574newHIVinfectionswerereport,withchildren(0-14)accountingfor23%,totalfemales(allages)accountingfor60%,andadolescentgirlsandyoungwomen(AGYW15-24)contributing22%.DiseaseBurden|ThereisfurthervariationinHIVincidenceandthevolumeofnewinfectionsbygeography52014:VMMCAcceleratedStrategicCostedOperationalPlan,focusedonincreasingMCcoverageto80%inthepriorityagegroups2019:SustainabilityTransitionImplementationPlan(STIP)2019–2021),aimedtomaximizethelong-termimpactofVMMCthroughscale-uptargetsandsustainablecoverage.FromaverticalVMMCimplementationtointegrated,government-ledbiomedicalprevention6FromaVerticalMCProgramtoIntegratedPxProgrammingFromaverticalVMMCimplementationtointegrated,government-ledbiomedicalprevention7CombinedHIV/STIStrategyVisionAnAIDSfreeZimbabwegenerationwhereallpopulationshavehealthylivesandwellbeing.GoalToacceleratecountry'sresponsetowardsendingAIDSasapublichealthprobleminZimbabweby2030.Sub-GoalsToreduceHIVincidenceinZimbabweby50%from0.5in2018tolessthan0.25by2025.ToreduceAIDSrelateddeathsinZimbabweby60%from21,800in2018tolessthan10,000in2025.SignificantlyreduceHIVandAIDSrelatedstigmaanddiscriminationamongallpopulationsby2025.8DifferentiatedPrevention|TheHIVPreventionProgrammingMix8TherightcombinationandbalancetoinformoptimaldecisionmakingforreducingHIVincidenceandtherebyforhealthimpact●ForTheRightPeople●InTheRightLocations●WithTheRightInterventions●AtTheRightTime●InTheRightWay●AtTheRightCostPolicy/EnablingEnvironment(national,state,locallaws)Organisational(organisationsandsocialinstitutions)Community(relationshipsbetweenorganisations)Interpersonal(families,friends,socialnetworks)Individual(knowledge,attitude,behaviours)DiseaseBurden|DistrictsContributingtothe9KeyObservationsDiseaseburdenisconcentratedwherethereishighestpopulation(urbanareas).Thetop15districtscontributeto48%ofthetotalnewHIVInfections.Top15DistrictsbyNewHIVInfectionsInconclusionVMMCremainscriticaltotheHIV