District-level differentiated HIV testing strategies are needed to achieve the 1st 90 in Zimbabwe

Abstract Objective Despite the improvement towards the 90-90-90 targets, more than 25% of people living with HIV in Zimbabwe still do not know their HIV status. We used data from a recently published survey to recommend district-level HIV testing strategies based on HIV prevalence and antiretroviral therapy coverage to implementers and policy makers. Results Of the 62 districts in Zimbabwe 38% were in the low HIV prevalence /low antiretroviral therapy coverage, 34% in low HIV prevalence /high antiretroviral therapy coverage, 15% in high HIV prevalence/high antiretroviral therapy coverage and 13% in high HIV prevalence/low antiretroviral therapy coverage categories. Districts with low HIV prevalence and low antiretroviral therapy coverage should employ targeted HIV testing approaches (index case testing, targeting sexual partners and HIV exposed infants; intensified provider initiated testing; key populations and hot spots). Those with high HIV prevalence and low antiretroviral therapy coverage should focus on expanding access to HIV testing to the community. Districts with already high antiretroviral therapy coverage should move to targeted HIV testing so that the few yet to be tested are reached. Further exploration to assess other contextual factors in the cascade of care beyond HIV testing is warranted to achieve the 90-90-90 strategies.