Zimbabwe's Maturing HIV Epidemic: A Triangulation Analysis of Prevalence, Behavioral, and Programmatic Data from 2000-2013 Open Access

Sizemore, Emma Katherine (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/xp68kg987?locale=en
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Abstract

Objective:

To assess Zimbabwe's HIV prevalence trends from 2000-2013 in light of recent behavioral and programmatic data, a data triangulation exercise including a systematic review of the available data on the HIV/AIDS epidemic and national response in Zimbabwe was conducted.

Materials and Methods:

HIV prevalence estimations from Zimbabwe's antenatal clinic sentinel surveillance were compared alongside data from the 2005/06 and 2010/11 DHS surveys and estimations generated using the USAID Spectrum software. Behavioral indicator data among men and women from the two DHS surveys were analyzed, and governmental programmatic data were assessed.

Results:

Zimbabwe's HIV prevalence among pregnant women declined from 32.1% to 15.5% from 2000 to 2012, with declines also seen in the two DHS surveys. Comprehensive knowledge of HIV/AIDS increased (from 46.5% to 53.0% among men, p<0.001, and from 43.4% to 55.9% among women, p<0.001) and self-reported condom use during most recent sex increased (from 16.2% to 18.1% among men and from 5.5% to 9.8% among women, p<0.01), while the mean number of lifetime partners increased among women (from 1.6 to 2.2, p<0.001) and the proportion of men reporting two or more partners in the last year rose (from 9.0% to 10.5%, p<0.01). Testing rates increased from 45.6 to 141.7 per 1,000 men and 56.1 to 162.8 per 1,000 women from 2008 to 2013 (p<0.001). Condom distribution rates increased by nearly 350% from 2008 to 2013 and rates of male circumcision grew tenfold from 2010 to 2013. ART coverage fluctuated from 2009 to 2013 while AIDS-related mortality declined.

Conclusions:

Zimbabwe's well-documented behavior change in the early 2000s in the setting of high exposure to AIDS-mortality may not be sustained as rates of some risky behaviors are on the rise. Policy-makers must now address geographic disparities in HIV prevalence and work to reverse the growing epidemic in these areas.

Table of Contents

Table of Contents

Chapter 1 - Literature Review................................................................................................ 1

Introduction to Zimbabwe......................................................................................................................................... 2

HIV/AIDS in Zimbabwe................................................................................................................................................. 3

Behavior Change............................................................................................................................................................... 4

Condom Distribution..................................................................................................................................................... 9

Voluntary Counseling and Testing.................................................................................................................... 11

Antiretroviral Therapy............................................................................................................................................. 13

Male Circumcision........................................................................................................................................................ 15

Summary............................................................................................................................................................................. 16

Works Cited....................................................................................................................................................................... 20

Chapter 2 - Manuscript.......................................................................................................... 28

Contribution of Student............................................................................................................................................ 30

Abstract............................................................................................................................................................................... 31

Introduction..................................................................................................................................................................... 32

Materials and Methods.............................................................................................................................................. 33

Data Triangulation........................................................................................................................................................ 33

Data Sources.................................................................................................................................................................... 35

ANC Sentinel Surveillance Data............................................................................................................................... 35

2005/06 and 2010/11 DHS Data............................................................................................................................ 35

Spectrum Estimations................................................................................................................................................ 36

Programmatic Data..................................................................................................................................................... 37

Statistical Analyses....................................................................................................................................................... 37

Ethical Considerations................................................................................................................................................ 37

Results.................................................................................................................................................................................. 38

HIV Prevalence.............................................................................................................................................................. 38

Behavioral Indicators.................................................................................................................................................. 42

Voluntary Testing and Counseling......................................................................................................................... 44

Condom Distribution and STI Rates...................................................................................................................... 46

Voluntary Medical Male Circumcision................................................................................................................. 47

ART and PMTCT............................................................................................................................................................ 48

AIDS-Related Mortality.............................................................................................................................................. 50

Discussion.......................................................................................................................................................................... 50

Works Cited....................................................................................................................................................................... 59

Chapter 3 - Implications and Recommendations............................................................ 66

Appendices................................................................................................................................ 72

Appendix 1. 2005/06 and 2010/11 DHS Behavioral Indicator Data by Province for Men Aged 15-49 Years................................................................................................................................................................................................... 73

Appendix 2. 2005/06 and 2010/11 DHS Behavioral Indicator Data by Province for Women Aged 15-49 Years...................................................................................................................................................................................... 74

Appendix 3. NAC Spectrum Software District Prevalence Estimations and Reported Quality of Estimations, 2013......................................................................................................................................................... 75

Appendix 4. Scientific Poster................................................................................................................................ 77


Figure 1. HIV Prevalence Among Women 15-49 Years (ANC Surveillance, DHS, and Spectrum Estimations) 38

Figure 2. HIV Prevalence by District in 2013 (ANC Surveillance)............................................. 39

Figure 3. HIV Prevalence Among Women By Age (ANC Surveillance and DHS).................... 40

Figure 4. HIV Prevalence Among Three Synthetic Age Cohorts of Women (ANC Surveillance and DHS). 41

Table 1. Behavioral Indicators from the 2005/06 and 2010/11 DHS Surveys (DHS)................. 43

Figure 5. Voluntary Testing and Counseling Rates Per 1000 Men By Age (NAC Data)............ 45

Figure 6. Voluntary Counseling and Testing Rates Per 1000 Women (NAC Data).................... 46

Figure 7. Condom Distribution and STI Rates Among Men and Women (NAC Data).............. 47

Figure 8. Clinical Circumcision Rates Per 1000 Men By Age (MOHCW).................................. 48

Figure 9. Estimated ART Coverage Among Adults, Children, and Women Needing PMTCT (MOHCW, NAC, and Spectrum).............................................................................................................................. 49

Figure 10. Estimated Annual AIDS-Related Deaths (Spectrum and NAC 2014)...................... 50

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