Assessing the Impact of Extreme Weather Events on HIV and Tuberculosis Care in Zimbabwe

The growing threat to health systems posed by extreme weather events (EWEs) disproportionately affects people living with HIV (PLHIV) and tuberculosis (TB) in high-burden, low-resource settings. In Zimbabwe, for example, the 2023/2024 El Nino-induced drought intensified food insecurity and reduced access to clinics and medication for vulnerable populations. We conducted a formative evaluation to assess how recent EWEs in Zimbabwe have impacted HIV and TB care in this community and to identify potential climate-adaptive health-service strategies. First, we surveyed 1,804 PLHIV across 321 clinics in Zimbabwe to describe their perceptions of EWEs on their health. We conducted focus group discussions (n=6) with HIV and TB affected individuals. The majority of survey participants (76%, 1363/1804) reported noticing changes in climate over the past 5 years with 75% (n=1024) reporting disruptions to their HIV care due to these changes. Survey respondents reported climate-related disruptions led to increased food insecurity (86%, 877/1024) and water shortages (65%, 667/1024) that were dominant barriers to treatment adherence. Qualitative analysis confirmed barriers to HIV and TB care from extreme weather events included widespread food insecurity, crop failures and livestock deaths, with consequent impacts on income leading to challenges paying for food and transportation to clinics. Participants highlighted the need for expanded interventions that facilitate social and economic supports, including nutrition support, water access, transportation, and income-generating activities, as well as decentralized models of healthcare delivery. Findings underscore the urgent need for integrated, climate-adaptive strategies to maintain HIV and TB care continuity in climate-vulnerable regions like Zimbabwe. Panel: Research in ContextO_TEXTBOXEvidence before this study Previous studies have shown that climate shocks such as droughts, flooding, and heat waves have important consequences for social and structural determinants of health, including food insecurity, water access, livelihoods, and mobility, and that these determinants can influence HIV and TB risk and outcomes. However, almost all available evidence has been conceptual rather than empirical. Few studies have examined patient-reported impacts of extreme weather events on HIV or TB care, and none have assessed climate-adaptive health-service strategies identified directly by affected communities and frontline health workers in Zimbabwe or similar high-burden, climate-vulnerable settings. Added value of this study This study provides formative empirical evidence on how extreme weather events disrupt HIV and TB care from the perspective of people living with HIV, people affected by TB, and health-care workers. Using a large multi-district patient survey alongside qualitative data, we document how climate-related food insecurity, water scarcity, financial strain, mental health stress, and transportation barriers undermine treatment adherence and continuity of care. Further, the study identifies community-prioritized strategies to sustain HIV and TB care during climate shocks, including nutrition and water support, transportation assistance, decentralized service delivery, and livelihood interventions. Implications of all available evidence As climate change intensifies, strategies that protect continuity of HIV and TB care will be increasingly essential in high-burden settings. Findings suggest that social protection and decentralized health-service models may mitigate climate-related disruptions to treatment, promote resilience, and reduce the structural burden placed on patients. Integrating climate-adaptive approaches into HIV and TB programming could strengthen health-system preparedness and promote sustainable long-term outcomes for climate-vulnerable populations. C_TEXTBOX