{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:55:52Z","timestamp":1791582952431,"version":"4.3.4"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T00:00:00Z","timestamp":1663891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH114562\u201301"],"award-info":[{"award-number":["R01MH114562\u201301"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-09999"],"award-info":[{"award-number":["INV-09999"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Medical Research Council Centre for Global Infectious Disease Analysis","award":["MR\/R015600\/ 1"],"award-info":[{"award-number":["MR\/R015600\/ 1"]}]},{"name":"Medical Research Council Centre for Global Infectious Disease Analysis","award":["MR\/R015600\/ 1"],"award-info":[{"award-number":["MR\/R015600\/ 1"]}]},{"name":"Medical Research Council Centre for Global Infectious Disease Analysis","award":["MR\/R015600\/ 1"],"award-info":[{"award-number":["MR\/R015600\/ 1"]}]},{"name":"Medical Research Council Centre for Global Infectious Disease Analysis","award":["MR\/R015600\/ 1"],"award-info":[{"award-number":["MR\/R015600\/ 1"]}]},{"name":"UK Medical Research Council and Foreign, Commonwealth & Development Office"},{"DOI":"10.13039\/501100013342","name":"NIHR Imperial Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013342","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Manicaland province in eastern Zimbabwe has a high incidence of HIV. Completion of the seventh round of the Manicaland Survey in 2018\u20132019 provided the opportunity to assess the state of the epidemic prior to the start of the COVID-19 pandemic. The study aims were to: a) estimate HIV seroprevalence and assess whether prevalence has declined since the last round of the survey (2012\u20132013), b) describe and analyse the socio-demographic and behavioural risk factors for HIV infection and c) describe the HIV treatment cascade.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Participants were administered individual questionnaires collecting data on socio-demographic characteristics, sexual relationships, HIV prevention methods and treatment access, and were tested for HIV. Descriptive analyses were followed by univariate and multivariate analyses of risk factors for HIV seropositvity using logistic regression modelling based on the proximate-determinants framework.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>HIV prevalence was 11.3% [95% CI; 10.6\u201312.0] and was higher in females than males up to 45\u201349 years. Since 2012\u20132013 HIV prevalence has significantly declined in 30\u201344 year-olds in males, and 20\u201344 year-olds in females. The HIV epidemic has aged since 2012\u20132013, with an increase in the mean age of HIV positive persons from 38 to 41 years. Socio-demographic determinants of HIV prevalence were church denomination in males, site-type, wealth-status, employment sector and alcohol use in females, and age and marital status in both sexes. Behavioural determinants associated with increased odds of HIV were a higher number of regular sexual partners (lifetime), non-regular sexual partners (lifetime) and condom use in both sexes, and early sexual debut and concomitant STIs in females; medical circumcision was protective in males. HIV status awareness among participants testing positive in our study was low at 66.2%. ART coverage amongst all participants testing positive for HIV in our study was 65.0% and was lower in urban areas than rural areas, particularly in males.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Prevalence has declined, and ART coverage increased, since 2012\u20132013. Majority of the associations with prevalence hypothesised by the theoretical framework were not observed in our data, likely due to underreporting of sexual risk behaviours or the treatment-as-prevention effect of ART curtailing the probability of transmission despite high levels of sexual risk behaviour. Further reductions in HIV incidence require strengthened primary prevention, HIV testing and linkage to risk behaviour counselling services. Our results serve as a valuable baseline against which to measure the impact of the COVID-19 pandemic on HIV prevalence and its determinants in Manicaland, Zimbabwe, and target interventions appropriately.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0273776","type":"journal-article","created":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T18:26:52Z","timestamp":1663957612000},"page":"e0273776","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Status of the HIV epidemic in Manicaland, east Zimbabwe prior to the outbreak of the COVID-19 pandemic"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2181-5180","authenticated-orcid":true,"given":"Adya","family":"Rao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa","family":"Moorhouse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rufu","family":"Maswera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tawanda","family":"Dadirai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phyllis","family":"Mandizvidza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance","family":"Nyamukapa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8030-3380","authenticated-orcid":true,"given":"Shevanthi","family":"Nayagam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Gregson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,23]]},"reference":[{"issue":"10258","key":"pone.0273776.ref001","first-page":"1204","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019.","volume":"396","author":"EM Abrams","year":"2020","journal-title":"The Lancet (British edition)."},{"key":"pone.0273776.ref002","volume-title":"HIV prevention cascades to improve programmes and interventions","author":"RM Schaefer","year":"2020"},{"key":"pone.0273776.ref003","unstructured":"United Nations General Assembly. Political Declaration on HIV and AIDS: On the Fast Track to Accelerating the Fight against HIV and to Ending the AIDS Epidemic by 2030. 2016."},{"key":"pone.0273776.ref004","unstructured":"UNAIDS. Fast-track commitments to end AIDS by 2030."},{"key":"pone.0273776.ref005","unstructured":"UNAIDS. Executive summary \u2060\u2014 2020 Global AIDS Update \u2060\u2014 Seizing the moment \u2060\u2014 Tackling entrenched inequalities to end epidemics."},{"key":"pone.0273776.ref006","unstructured":"UNAIDS. UNAIDS data 2019."},{"key":"pone.0273776.ref007","unstructured":"UNAIDS. AIDSinfo."},{"key":"pone.0273776.ref008","unstructured":"National Aids Council of Zimbabwe. Zimbabwe HIV & AIDS Strategy for the Informal Economy 2017\u20132020."},{"issue":"2","key":"pone.0273776.ref009","doi-asserted-by":"crossref","first-page":"e1000414","DOI":"10.1371\/journal.pmed.1000414","article-title":"A surprising prevention success: why did the HIV epidemic decline in Zimbabwe?","volume":"8","author":"DT Halperin","year":"2011","journal-title":"PLoS medicine."},{"key":"pone.0273776.ref010","unstructured":"World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach."},{"key":"pone.0273776.ref011","doi-asserted-by":"crossref","first-page":"102246","DOI":"10.1016\/j.healthplace.2019.102246","article-title":"The temporalities of policymaking: The case of HIV test-and-treat policy adoption in Zimbabwe.","volume":"61","author":"M Moran","year":"2020","journal-title":"Health & place."},{"key":"pone.0273776.ref012","unstructured":"National AIDS Council Zimbabwe. Extended Zimbabwe National HIV and AIDS Strategic Plan: 2015\u20132020."},{"key":"pone.0273776.ref013","unstructured":"Ministry of Child and Healthcare Zimbabwe. Zimbabwe National and Subnational HIV Estimates Report."},{"issue":"1","key":"pone.0273776.ref014","doi-asserted-by":"crossref","first-page":"190038","DOI":"10.1038\/sdata.2019.38","article-title":"The Subnational Human Development Database.","volume":"6","author":"J Smits","year":"2019","journal-title":"Scientific data"},{"issue":"10","key":"pone.0273776.ref015","doi-asserted-by":"crossref","first-page":"e015898","DOI":"10.1136\/bmjopen-2017-015898","article-title":"Documenting and explaining the HIV decline in east Zimbabwe: the Manicaland General Population Cohort","volume":"7","author":"S Gregson","year":"2017","journal-title":"BMJ Open"},{"issue":"5","key":"pone.0273776.ref016","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1093\/ije\/dyq055","article-title":"HIV decline in Zimbabwe due to reductions in risky sex? 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Questionnaires."},{"issue":"Suppl 2","key":"pone.0273776.ref027","first-page":"ii36","article-title":"Informal confidential voting interview methods and temporal changes in reported sexual risk behaviour for HIV transmission in sub-Saharan Africa","volume":"80","author":"S Gregson","year":"2004","journal-title":"Sexually Transmitted Infections"},{"issue":"1","key":"pone.0273776.ref028","doi-asserted-by":"crossref","first-page":"e0245720","DOI":"10.1371\/journal.pone.0245720","article-title":"Provision of HIV viral load testing services in Zimbabwe: Secondary data analyses using data from health facilities using the electronic Patient Monitoring System.","volume":"16","author":"T Apollo","year":"2021","journal-title":"PloS one."},{"key":"pone.0273776.ref029","unstructured":"World Health Organization. ANNEX: Technical guidance update on quality assurance for HIV rapid diagnostic tests."},{"issue":"Supplement-1","key":"pone.0273776.ref030","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1086\/425282","article-title":"Integrating Demographic and Epidemiological Approaches to Research on HIV\/AIDS: The Proximate-Determinants Framework","volume":"191","author":"JT Boerma","year":"2005","journal-title":"The Journal of infectious diseases"},{"key":"pone.0273776.ref031","unstructured":"ZIMPHIA. Zimbabwe Population-based HIV Impact Assessment 2020."},{"issue":"3","key":"pone.0273776.ref032","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1097\/QAD.0b013e3282f2aac3","article-title":"Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa","volume":"22","author":"JR Hargreaves","year":"2008","journal-title":"AIDS"},{"key":"pone.0273776.ref033","unstructured":"UNAIDS. Status of HIV Prevention Services in the Time of COVID-19."},{"key":"pone.0273776.ref034","unstructured":"World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021."},{"key":"pone.0273776.ref035","doi-asserted-by":"crossref","first-page":"100483","DOI":"10.1016\/j.eclinm.2020.100483","article-title":"Understanding the impact of interruptions to HIV services during the COVID-19 pandemic: A modelling study.","volume":"26","author":"BL Jewell","year":"2020","journal-title":"EClinicalMedicine."},{"issue":"2","key":"pone.0273776.ref036","first-page":"i72","article-title":"Reported number of sexual partners: comparison of data from four African longitudinal studies.(Trends in Sexual Behaviour and Marriage in sub-Saharan Africa)","volume":"85","author":"N McGrath","year":"2009","journal-title":"Sexually transmitted infections"},{"issue":"11","key":"pone.0273776.ref037","doi-asserted-by":"crossref","first-page":"e0162967","DOI":"10.1371\/journal.pone.0162967","article-title":"Rising Levels of HIV Infection in Older Adults in Eastern Zimbabwe.","volume":"11","author":"J Negin","year":"2016","journal-title":"PloS one."},{"issue":"1","key":"pone.0273776.ref038","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/QAI.0000000000002404","article-title":"Brief Report: HIV Incidence Among Older Adults in a Rural South African Setting: 2010\u20132015","volume":"85","author":"FX G\u00f3mez-Oliv\u00e9","year":"2020","journal-title":"Journal of Acquired Immune Deficiency Syndromes (1999)."},{"issue":"2","key":"pone.0273776.ref039","doi-asserted-by":"crossref","first-page":"e0148502","DOI":"10.1371\/journal.pone.0148502","article-title":"Sex Differences in HIV Prevalence Persist over Time: Evidence from 18 Countries in Sub-Saharan Africa.","volume":"11","author":"HK Hegdahl","year":"2016","journal-title":"PloS One."},{"issue":"9263","key":"pone.0273776.ref040","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/S0140-6736(00)04331-2","article-title":"Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai","volume":"357","author":"RH Gray","year":"2001","journal-title":"Uganda. The Lancet"},{"issue":"1","key":"pone.0273776.ref041","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/1742-6405-10-30","article-title":"Women and HIV in Sub-Saharan Africa","volume":"10","author":"G Ramjee","year":"2013","journal-title":"AIDS research and therapy"},{"issue":"1","key":"pone.0273776.ref042","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1093\/ije\/dym255","article-title":"HIV incidence in 3 years of follow-up of a Zimbabwe cohort\u20141998\u20132000 to 2001\u201303: contributions of proximate and underlying determinants to transmission.","volume":"37","author":"B Lopman","year":"2008","journal-title":"International Journal of Epidemiology"},{"issue":"11","key":"pone.0273776.ref043","doi-asserted-by":"crossref","first-page":"e298","DOI":"10.1371\/journal.pmed.0020298","article-title":"Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial.","volume":"2","author":"B Auvert","year":"2005","journal-title":"PLoS Medicine."},{"issue":"9562","key":"pone.0273776.ref044","first-page":"643","article-title":"Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial.","volume":"369","author":"RC Bailey","year":"2007","journal-title":"The Lancet (British edition)."},{"issue":"9562","key":"pone.0273776.ref045","first-page":"657","article-title":"Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial","volume":"369","author":"RH Gray","year":"2007","journal-title":"The Lancet (British edition)."},{"issue":"3","key":"pone.0273776.ref046","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1258\/0956462011917009","article-title":"A rural HIV epidemic in Zimbabwe? Findings from a population-based survey.","volume":"12","author":"S Gregson","year":"2001","journal-title":"International Journal of STD & AIDS"},{"issue":"1","key":"pone.0273776.ref047","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1093\/ije\/dym255","article-title":"HIV incidence in 3 years of follow-up of a Zimbabwe cohort\u20141998\u20132000 to 2001\u201303: contributions of proximate and underlying determinants to transmission.","volume":"37","author":"B Lopman","year":"2008","journal-title":"International journal of epidemiology"},{"issue":"5","key":"pone.0273776.ref048","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/j.healthplace.2011.06.004","article-title":"A multilevel analysis of the determinants and cross-national variations of HIV seropositivity in sub-Saharan Africa: Evidence from the DHS.","volume":"17","author":"M Magadi","year":"2011","journal-title":"Health & Place."},{"issue":"5","key":"pone.0273776.ref049","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.3390\/ijerph18052477","article-title":"Interventions to Improve Adherence to Antiretroviral Therapy (ART) in Sub-Saharan Africa: An Updated Systematic Review.","volume":"18","author":"PP Damulak","year":"2021","journal-title":"International journal of environmental research and public health."},{"issue":"1","key":"pone.0273776.ref050","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s12961-018-0358-1","article-title":"A longitudinal review of national HIV policy and progress made in health facility implementation in Eastern Zimbabwe","volume":"16","author":"M Tlhajoane","year":"2018","journal-title":"Health research policy and systems"},{"key":"pone.0273776.ref051","unstructured":"Mavedzenge SN, Sibanda E, Mavengere Y, Dirawo J. 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