High Levels of Pre-Treatment HIV Drug Resistance in Zimbabwe: Is this a Threat to HIV/AIDS Control?

Zimbabwe is one of the countries in Southern Africa most affected by the Human Immunodeficiency Virus (HIV) epidemic. The country has the third highest HIV prevalence (12.5% among 15-49 years) in the region, with an estimated 1.4 million people living with HIV (PLHIV) to date [1]. New infections (35,000) and AIDSrelated deaths (20,000) in all ages were recently (2020) updated [1]. However, Zimbabwe has made enormous strides in scaling up access to HIV testing and treating. Consequently, the progress made towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-9090 targets set for 2020 has been remarkably successful. Ninety percent of PLHIV were aware of their status, 94% of those diagnosed were on antiretroviral therapy (ART) and 86% of PLHIV on ART were virally suppressed [1]. In many resource-limited settings (RLS) including Zimbabwe; reduced adherence, limited access to viral load (VL) monitoring and HIV drug resistance mutation (DRM) analysis, make managing HIV more difficult. These factors contribute to virologic failure and the emergence of ART resistance [2,3]. Drug resistance is a serious threat to the global scale-up of HIV treatment particularly in many RLS with limited ART treatment options.