Changes in Use of HIV Prevention Methods in East Zimbabwe over the Course of the COVID-19 Pandemic: A Longitudinal Population Study

IntroductionCOVID-19 posed substantial challenges for sustaining use of HIV prevention services in sub-Saharan African populations. However, data on changes in use of HIV primary prevention methods within the general population over the course of the pandemic remain scarce. We investigated these changes in east Zimbabwe. MethodsData were taken from three rounds of a large-scale open-cohort population survey conducted before (July 2018 to December 2019), during (February to July 2021), and after (July 2022 to March 2023) stringent COVID-19 control measures. Changes in use of HIV prevention methods, underlying sexual risk-behaviours for HIV acquisition, and socio-demographic determinants were measured using descriptive statistics and logistic regression analyses of serial cross-sectional and cohort data. ResultsIn the serial cross-sectional analysis, in uninfected men, use of HIV prevention methods in non-regular sexual partnerships decreased from 40.4% (N=261) before COVID-19 to 35.3% during COVID-19 (AOR=0.79, 95%CI, 0.56-1.12; N=295), and 27.1% after COVID-19 (AOR=0.57, 0.39-0.83; N=293). This decrease reflected primarily a reduction in use of male condoms. No changes were found in overall use of HIV prevention methods in non-regular sexual partnerships in uninfected women. In women with sexual risk behaviours, PrEP use rose from 0.5% (N=1001) before COVID-19 to 3.2% during COVID-19 (AOR=6.07, 2.29-16.13; N=785), and 4.2% after COVID-19 (AOR=7.54, 2.93-19.41; N=928). 19.3%, 20.2% and 21.3% of sexually active men in the before, during and after COVID-19 surveys, respectively, reported a non-regular partnership in the last 12 months. The corresponding proportions for women were 8.3%, 7.2% and 7.1%. Similar results were found in the cohort analyses. ConclusionIn east Zimbabwe, men engaging in non-regular partnerships had lower use of HIV prevention methods during and after the COVID-19 pandemic than before the pandemic despite continuing high levels of sexual risk behaviour. In women, increases in PrEP use partly compensated for lower use of other prevention methods. Epidemic preparedness plans should ensure that access to HIV prevention methods is maintained.