A Status-Neutral Approach to HIV - Is Targeted Testing Still Relevant South of Sahara?

IntroductionIn 2022, UNAIDS replaced the 90% Global HIV targets with six Comprehensive 95% targets that include linkage to comprehensive HIV prevention services, the thrust of the status-neutral approach to HIV testing. Zimbabwe has been implementing both targeted testing and the status-neutral concept. In this paper, we analyse the role of status-neutral concepts in targeted testing, for effective case identification and linkage to prevention and treatment services. MethodsWe conducted a cross-sectional study on 36 multi-stage sampled sites across 4/10 provinces of Zimbabwe. Screened and non-screened patients were tested and analysed for positivity ratios and linkage to post-test services. Data were extracted using Epicollect5 and imported into EpiData software and Stata for cleaning and analysis. Data were summarized as proportions, odds ratios and adjusted odds ratios at 5% significance level. ResultsOf 23,058 HIV tests done, females constituted 55% (n=12,698), whilst 63.5% (n=14,650) were retests and positivity of 7.5% obtained. Screened patients contributed 75.1% to the overall positivity (1,296/1,727), from 66% (n=15,289) of the total tests conducted. 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), from an 8% (n=912) positivity ratio. 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 ConclusionTargeted and status-neutral testing are related and complimentary concepts which, when simultaneously applied, potentiates case identification through prioritizing high-risk individuals for testing, as well as arresting ongoing transmission of HIV through effective linkage to HIV prevention and treatment. This approach facilitates economic usage of limited resources, in generalized epidemics.