Malawi, Zambia and Zimbabwe are making strong progress towards achieving the treatment and viral suppression goals set out in the UN 90-90-90 target, and new HIV infections have declined substantially in each country since 2003, according to figures from national household surveys released last week by ICAP at Columbia University.

“New findings from Malawi, Zambia, and Zimbabwe validate what we have only been able to previously predict in models-that our global efforts are having a measurable impact in countries with some of the most severe HIV epidemics,” said Dr. Shannon Hader, director of the CDC Division of Global HIV and Tuberculosis.

The surveys show that each country is close to meeting the targets for people on treatment and for viral suppression, but that they still have some way to go to meet the HIV diagnosis target.

The findings come from national population HIV impact assessments carried out in 2015 and 2016 to measure progress towards the 90-90-90 goals. The targets call for countries to achieve the following goals by 2020:

• 90% of people living with HIV diagnosed

• 90% of people diagnosed with HIV on antiretroviral treatment

• 90% of people on treatment with fully suppressed viral load.

The surveys were carried out by interviewing pre-selected household members about household characteristics and potential risk factors for HIV.

All participants were offered free and confidential HIV testing and counselling. Anyone who tested positive for HIV was offered a point-of-care CD4 count in their home, and had blood drawn for viral load testing.

Approximately 80,000 adults and children consented to take part in the surveys across the three countries.

Surveys are taking place in 16 countries supported by PEPFAR (the US President’s Emergency Plan for AIDS Relief) in 2016 and 2017; the results from Malawi, Zambia and Zimbabwe are the first to be made available.

HIV Incidence

HIV incidence was assessed by identifying recent infections through use of a laboratory combined antibody/antigen test. HIV incidence has been halved in comparison to 2003 in all three countries.

• In Malawi annual HIV incidence has declined from approximately 1.3-1.5% to 0.37%, corresponding to approximately 28,000 new infections a year among adults aged 16 to 64 years.

• In Zambia annual HIV incidence has declined from approximately 1.3-1.5% to 0.66%, corresponding to approximately 46,000 new infections a year among adults aged 15 to 59 (note that Zambia’s survey used a different age range).

• In Zimbabwe annual HIV incidence has declined from approximately 1.3-1.5% to 0.45%, corresponding to approximately 32,000 new infections a year among adults aged 16 to 64 years.

HIV prevalence

HIV prevalence in each country has changed little since national surveys carried out in 2010. HIV prevalence is 10.6% in Malawi (around 900,000 people living with HIV), 12.3% in Zambia (980,000) and 14.6% in Zimbabwe (1.2 million people).

These national averages disguise big variations in HIV prevalence according to age.

In Zimbabwe almost 30% of women aged 40-44 are living with HIV. In Zimbabwean men the peak prevalence is in the 45-49 age group, where almost 30% of men are living with HIV. In the 20-24 age group three young women are living with HIV for every young man (8.5% vs 2.7%). 

A similar pattern is evident in Malawi in the 25-29 age group, where three women are living with HIV for every man (14.1% vs 4.8%).

In Zambia four young women are living with HIV for every young man in the 20-24 age group (8.6% vs 2.1%).

HIV prevalence in children (0-14 years) was 1.6% in Malawi, 1.3% in Zambia and 1.4% in Zimbabwe

ZAMBIA

In Zambia the difference in viral suppression by age was even more pronounced than in Malawi, whereas a gender difference in viral suppression was only evident in the 25-34 age group.

Around 30% of those aged 15-24 were virally suppressed, compared to around 70% of those aged 45-59. Viral suppression varied from 50% in the Northern district to 67.8% in the Eastern district.