{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T07:20:54Z","timestamp":1768634454941,"version":"3.49.0"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T00:00:00Z","timestamp":1600905600000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008196","name":"M\u00e9decins Sans Fronti\u00e8res","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. Intern. AIDS Soc."],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Gutu, a rural district in Zimbabwe, has been implementing comprehensive HIV care with the support of M\u00e9decins Sans Fronti\u00e8res (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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross\u2010sectional study was implemented between September and December 2016. Using multistage cluster sampling, individuals aged \u226515\u00a0years 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\u2010positive had their HIV\u2010RNA viral load (VL) measured, regardless of their antiretroviral therapy (ART) status, and those not on ART with HIV\u2010RNA VL\u00a0\u2265\u00a01000\u00a0copies\/mL had Limiting\u2010Antigen\u2010Avidity EIA Assay for cross\u2010sectional estimation of population\u2010level HIV incidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 5439 eligible adults \u226515\u00a0years 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\u2010positive 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\u2010positive participants was 83.0% (95% CI: 80.0 to 85.7). Overall, 71.6% (95% CI 68.0 to 75.0) of HIV\u2010infected participants had a HIV\u2010RNA VL\u00a0&lt;\u00a01000\u00a0copies\/mL. Women achieved higher outcomes than men in the five stages of the cascade of care. Viral Load Suppression (VLS) among participants on ART was 83.2% (95% CI: 79.7 to 86.2) and was not statistically different between women and men (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.98). The overall HIV incidence was estimated at 0.35% (95% CI 0.00 to 0.70) equivalent to 35 new cases\/10,000 person\u2010years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study provides population\u2010level evidence that achievement of HIV cascade of care coverage overall and among women is feasible in a context with broad access to services and implementation of a decentralized model of care. However, the VLS was relatively low even among participants on ART. Quality care remains the most critical gap in the cascade of care to further reduce mortality and HIV transmission.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25613","type":"journal-article","created":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T11:58:00Z","timestamp":1600948680000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Successes and gaps in the HIV cascade of care of a high HIV prevalence setting in Zimbabwe: a population\u2010based survey"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7182-4934","authenticated-orcid":false,"given":"Nolwenn","family":"Conan","sequence":"first","affiliation":[{"name":"Epicentre Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca M","family":"Coulborn","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica","family":"Simons","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abraham","family":"Mapfumo","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res (MSF) Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsitsi","family":"Apollo","sequence":"additional","affiliation":[{"name":"Ministry of Health and Child Care Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela B","family":"Garone","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res (MSF) Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4141-2397","authenticated-orcid":false,"given":"Esther C","family":"Casas","sequence":"additional","affiliation":[{"name":"Southern Africa Medical Unit MSF Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian J","family":"Puren","sequence":"additional","affiliation":[{"name":"National Institute for Communicable Diseases (NICD) National Health Laboratory Service Johannesburg South Africa"},{"name":"Division of Virology, School of Pathology University of the Witwatersrand Medical School Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Menard L","family":"Chihana","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Maman","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,9,24]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Ministry of Health and Child Care (MOHCC).Zimbabwe Population\u2010based HIV Impact Assessment (ZIMPHIA) 2016: first report. 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