Lusaka — The U.S. Government and the Zambia Ministry of Health released the initial results of a groundbreaking survey: the Zambia Population-based HIV Impact Assessment (ZAMPHIA) on December 1, 2016. ZAMPHIA is a nationally representative, population-based HIV survey that was launched on November 27, 2015. The survey measured the burden of HIV and the impact of Zambia’s HIV prevention, care, and treatment services. Zambia is one of the first three countries to implement this groundbreaking, detailed population-based HIV impact assessment (PHIA) survey. PHIA surveys will be implemented in at least 13 countries, primarily in sub-Saharan Africa. The implementation of ZAMPHIA has set a global example for how the next PHIA surveys will be carried out.
Over the course of six months in 2016, 12,130 randomly selected households from across Zambia were visited by ZAMPHIA field teams. The teams included nurses and interviewers. Men, women, and children of all ages could participate in the survey, regardless of HIV status. Consent was obtained from the participants, including the parents of participating children, before completing a questionnaire and conducting the HIV test. Handheld computers were used to collect the information via a face-to-face interview. Survey staff were provided free HIV counseling and returned test results for HIV and syphilis to participants the same day and in the privacy and comfort of people’s homes. Those who tested positive for HIV or syphilis were referred for care at the nearest MOH health facility.
The primary objectives of ZAMPHIA are to estimate HIV incidence (new HIV infections) at a national level, and to estimate the national and provincial HIV prevalence (current HIV infections) and prevalence of suppressed HIV viral load (proportion of people living with HIV who have less than 1,000 copies of HIV virus per ml of blood) in a nationally representative sample of adults as well as children. The survey found that 12.3 percent of adults ages 15 to 59 are living with HIV and approximately 46,000 new cases of HIV occur every year. Of all persons living with HIV in Zambia, 59.8 percent are virally suppressed, meaning that the amount of HIV virus in an infected individual’s blood is below the threshold that would put them at greater risk for developing HIV-related disease and transmitting the virus to others. The provincial prevalence of suppressed HIV viral load varies from 50 percent in Northern Province to 67 percent in Eastern Province. ZAMPHIA also estimates pediatric prevalence of HIV (proportion of children living with HIV) for the first time in Zambia. The survey found that 1.3 percent of children aged 0-14 are living with HIV.
The initial ZAMPHIA results reveal that Zambia has achieved 67-85-89 towards the UNAIDS 90-90-90 targets, meaning about 67 percent of people living with HIV in Zambia know their status, 85 percent of all people diagnosed with HIV who are receiving antiretroviral therapy (ART), and 89 percent of people receiving ART are virally suppressed. More detailed data from the survey will be released in 2017. These results show that Zambia has made enormous progress in the fight against HIV, but there is still a need to keep the focus to expand the reach of HIV services.
ZAMPHIA is led by the Zambia Ministry of Health, with financial and technical assistance from the US Government President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC) and the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University. The Zambian Ministry of Health is implementing ZAMPHIA in partnership with the Central Statistical Office (CSO), Tropical Diseases Research Centre, and University of Zambia.
PEPFAR is implemented by the following U.S. government agencies: CDC, U.S. Agency for International Development (USAID), Department of Defense, Peace Corps, and Department of State. Through PEPFAR, the U.S. Government is committed to supporting the implementation of HIV and AIDS activities in Zambia and in particular, this first HIV impact assessment. Since PEPFAR began supporting the Zambian fight against HIV in 2004, the U.S. government has provided over $3 billion in assistance to the Government of the Republic of Zambia. The full findings of the ZAMPHIA survey will provide a comprehensive set of HIV and AIDS indicators that will inform HIV programming as Zambia strives to attain epidemic control and continue to work towards the goal of reaching an AIDS-free generation. Zambia’s success in combating HIV is the result of a well-coordinated approach to the national response by government. ZAMPHIA is more than just a national survey; its findings will also help inform regional and global priorities for ending the HIV epidemic. Both the Zambian and U.S. governments are excited about the initial ZAMPHIA results and their collaboration in the HIV response.