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

Introduction In 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. Methods We 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. Results Of 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 Conclusion Targeted 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. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial N.A ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval to conduct this study was obtained from the Ministry of Health and Childcare head office. The study was based on data collected into the DHIS2 electronic database which does not include patient identifying data. The study was therefore exempted from ethical clearances. No primary data was collected. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable All relevant data are within the manuscript and its Supporting Information files.