BACKGROUND: Zambia, which is experiencing a generalized HIV epidemic, adopted the UNAIDS 95/95/95 targets to diagnose 95% of all people living with HIV (PLHIV), treat with antiretroviral therapy (ART) 95% of diagnosed PLHIV, and virally suppress (i.e., HIV RNA <1,000 copies/ml) 95% of treated PLHIV by 2025. The Zambia Population-Based HIV Impact Assessment (ZAMPHIA) was conducted in 2021 and 2016 to measure progress toward these goals.
METHODS: ZAMPHIA 2021 was a nationally representative cross-sectional survey of persons aged =15 years conducted in Zambia from May to December 2021. We estimated the UNAIDS 95/95/95 targets for Zambia. Zambia implemented a test and treat policy for HIV in 2016, so we compared 2021 results with ZAMPHIA 2016, restricting to the overlapping ages between surveys (i.e.,15-59 years). Findings were for those who participated in whole blood collection. All analyses were weighted and accounted for survey design.
RESULTS: Out of 22,262 persons aged =15 years enrolled in the survey, 18,804 (84.5%) provided a blood specimen. In 2021, 88.7% PLHIV aged =15 years were aware of their HIV positive status, 98.0% of those were on ART, and 96.3% of those on ART were virally suppressed. Compared to 2016, there was substantial progress toward the 95/95/95 targets for PLHIV aged 15-59 years in 2021 (Table). Younger PLHIV (i.e., 15-24 and 25-34 age groups) had lower HIV status awareness than older PLHIV. Additionally, there was notable variation in achievement identifying PLHIV (first 95) by province.


CONCLUSIONS: Zambia achieved the 2^nd and 3^rd 95 targets after implementing a test and treat strategy. Despite notable progress in finding younger PLHIV since 2016, Zambia needs to enhance case finding in this group to reach UNAIDS targets. Additionally, best practices for case finding and treatment initiation and maintenance from better performing areas can be adapted in lower performing areas.?