Successes and gaps in the HIV cascade of care of a high HIV prevalence setting in Zimbabwe: a population‐based survey

Introduction Gutu, a rural district in Zimbabwe, has been implementing comprehensive HIV care with the support of Médecins Sans Frontières (MSF) since 2011, decentralizing testing and treatment services to all rural healthcare facilities. We evaluated HIV prevalence, incidence and the cascade of care, in Gutu District five years after MSF began its activities. Methods A cross‐sectional study was implemented between September and December 2016. Using multistage cluster sampling, individuals aged ≥15 years living in the selected households were eligible. Individuals who agreed to participate were interviewed and tested for HIV at home. All participants who tested HIV‐positive had their HIV‐RNA viral load (VL) measured, regardless of their antiretroviral therapy (ART) status, and those not on ART with HIV‐RNA VL ≥ 1000 copies/mL had Limiting‐Antigen‐Avidity EIA Assay for cross‐sectional estimation of population‐level HIV incidence. Results Among 5439 eligible adults ≥15 years old, 89.0% of adults were included in the study and accepted an HIV test. The overall prevalence was 13.6% (95%: Confidence Interval (CI): 12.6 to 14.5). Overall HIV‐positive status awareness was 87.4% (95% CI: 84.7 to 89.8), linkage to care 85.5% (95% CI: 82.5 to 88.0) and participants in care 83.8% (95% CI: 80.7 to 86.4). ART coverage among HIV‐positive participants was 83.0% (95% CI: 80.0 to 85.7). Overall, 71.6% (95% CI 68.0 to 75.0) of HIV‐infected participants had a HIV‐RNA VL