Integrating status-neutral and targeted HIV testing in Zimbabwe: A complementary strategy

Introduction Zimbabwe exclusively implemented targeted HIV testing until 2022 when Status-neutral testing was embraced. Whilst targeted testing aims to expand access and uptake of testing among high-risk individuals, status-neutral testing emphasizes post-test linkage to prevention and treatment services. To address how the two concepts relate in practice, we explored how status-neutral and targeted testing concepts correlate, in developing a double-edged strategy for effective case identification and linkage to prevention and treatment. Methods We conducted a cross-sectional study on 36 multi-stage sampled sites across 4/10 provinces of Zimbabwe. A national screening algorithm was used to determine patient risk profiling and eligibility for testing. Screened-out patients were offered HIVST. Both screened and non-screened patients were tested and analysed for positivity ratios and linkage to post-test services. Epicollect5 was used to collect data and analysed using EpiData software and Stata. Univariate, bivariate and multivariate analyses were conducted at a 5% significance level. Results Of 23,058 HIV tests done, females constituted 55% (n = 12,698), whilst 63.5% (n = 14,650) were retested. Through screening, at-risk patients contributed 75.1% to the overall positivity (1,296/1,727), from 66% (n = 15,289) of the total HIV tests conducted. All screened-out patients were non-reactive on HIVST: 1,182/1,182. The 45–49-year category was 3.6 times more likely to test positive (a95%CI:2.67,4.90). Males were 3.09 times more likely to test positive in adjusted analysis (a95%CI: 2.74, 3.49). First tests were 65% more likely to test HIV positive (a95%CI: 1.43, 1.91) whilst screened patients were 3.89 times more likely to link to HIV prevention services (a95%CI: 3.05, 4.97), against 25.5% (n = 1,871) linkage among patients not screened. Conclusion The complementarity of the status-neutral and targeted testing approaches is evident from our results. By prioritizing high-risk individuals for testing and ensuring ...