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Knowledge of and willingness to take PrEP in Zimbabwe â?? an analysis of the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) 2020
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BACKGROUND: In 2018, Zimbabwe launched pre-exposure prophylaxis (PrEP) as an HIV prevention strategy for those at high-risk of HIV infection. This analysis uses Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) 2020 data to investigate characteristics associated with knowledge of and willingness to take PrEP.
METHODS: ZIMPHIA 2020 is a nationally-representative, cross-sectional, HIV-focused survey among adults age 15+ in randomly selected households. We examined associations between sociodemographic characteristics and risk-taking and health-seeking behaviors with knowledge of and willingness to take PrEP. Factors significantly associated with the outcomes (p<0.05) in bivariate logistic regression models were included in multivariable models, stratified by sex, using jackknife methods to estimate variance.
RESULTS: Among the sample population, (males=4,527; females=7,392), 9.99% of males and 10.95% of females heard of PrEP. Among those testing HIV-negative (males=3,743; females=5,701), 68.03% of males and 64.33% of females indicated willingness to take PrEP. Males (aOR 4.14 [95%CI: 2.51-6.83]) and females (aOR 2.46 [95%CI: 1.69-3.59]) with above a secondary education were more likely to have heard of PrEP than those with primary/no education. Males who tested for HIV in the last year (aOR 2.00 [95%CI: 1.31-3.07]) were also more likely to have heard of PrEP, and females ages 15-24 were more likely to have heard of PrEP (aOR 0.73 [95%CI: 0.55-0.96]) than those 35-44. Males ages 15-24 were more willing to take PrEP (aOR 1.38 [95%CI: 1.04-1.87]) than those 35-44, and divorced, separated, or widowed males were more willing to take PrEP (aOR 2.35 [95%CI: 1.52-3.63]) than those never married. Females were more willing to take PrEP if they worked for cash/goods as payment (aOR 1.21 [95%CI: 1.05-1.38]) or saw a healthcare worker in the last year (aOR 1.16 [95%CI: 1.00-1.33]).
CONCLUSIONS: Participants who did not access healthcare or had lower education were less likely to have knowledge of or be willing to take PrEP. Adolescent girls and young women (AGYW), who have disproportionately high-risk of infection, are also less likely to have heard of PrEP. These results highlight the importance of community-based demand creation and education and scale-up of differentiated service delivery models, including AGYW-specific prevention programs, to better reach those at risk of HIV.
METHODS: ZIMPHIA 2020 is a nationally-representative, cross-sectional, HIV-focused survey among adults age 15+ in randomly selected households. We examined associations between sociodemographic characteristics and risk-taking and health-seeking behaviors with knowledge of and willingness to take PrEP. Factors significantly associated with the outcomes (p<0.05) in bivariate logistic regression models were included in multivariable models, stratified by sex, using jackknife methods to estimate variance.
RESULTS: Among the sample population, (males=4,527; females=7,392), 9.99% of males and 10.95% of females heard of PrEP. Among those testing HIV-negative (males=3,743; females=5,701), 68.03% of males and 64.33% of females indicated willingness to take PrEP. Males (aOR 4.14 [95%CI: 2.51-6.83]) and females (aOR 2.46 [95%CI: 1.69-3.59]) with above a secondary education were more likely to have heard of PrEP than those with primary/no education. Males who tested for HIV in the last year (aOR 2.00 [95%CI: 1.31-3.07]) were also more likely to have heard of PrEP, and females ages 15-24 were more likely to have heard of PrEP (aOR 0.73 [95%CI: 0.55-0.96]) than those 35-44. Males ages 15-24 were more willing to take PrEP (aOR 1.38 [95%CI: 1.04-1.87]) than those 35-44, and divorced, separated, or widowed males were more willing to take PrEP (aOR 2.35 [95%CI: 1.52-3.63]) than those never married. Females were more willing to take PrEP if they worked for cash/goods as payment (aOR 1.21 [95%CI: 1.05-1.38]) or saw a healthcare worker in the last year (aOR 1.16 [95%CI: 1.00-1.33]).
CONCLUSIONS: Participants who did not access healthcare or had lower education were less likely to have knowledge of or be willing to take PrEP. Adolescent girls and young women (AGYW), who have disproportionately high-risk of infection, are also less likely to have heard of PrEP. These results highlight the importance of community-based demand creation and education and scale-up of differentiated service delivery models, including AGYW-specific prevention programs, to better reach those at risk of HIV.