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Introduction In low? and middle?income settings, more than a third of HIV?positive individuals starting antiretroviral therapy (ART) present with advanced disease (CD4 ? 200 cells/mm[sup.3] ); over half of these [...], : Introduction: Many HIV?positive individuals in Africa have advanced disease when initiating antiretroviral therapy (ART) so have high risks of opportunistic infections and death. The REALITY trial found that an enhanced?prophylaxis package including fluconazole reduced mortality by 27% in individuals starting ART with CD4 Methods: The REALITY trial enrolled from June 2013 to April 2015. A decision?analytic model was developed to estimate the cost?effectiveness of six management strategies in individuals initiating ART in the REALITY trial countries. Strategies included standard?prophylaxis, enhanced?prophylaxis, standard?prophylaxis with fluconazole; and three CrAg testing strategies, the first stratifying individuals to enhanced?prophylaxis (CrAg?positive) or standard?prophylaxis (CrAg?negative), the second to enhanced?prophylaxis (CrAg?positive) or enhanced?prophylaxis without fluconazole (CrAg?negative) and the third to standard?prophylaxis with fluconazole (CrAg?positive) or without fluconazole (CrAg?negative). The model estimated costs, life?years and quality?adjusted life?years (QALY) over 48 weeks using three competing mortality risks: cryptococcal meningitis; tuberculosis, serious bacterial infection or other known cause; and unknown cause. Results: Enhanced?prophylaxis was cost?effective at cost?effectiveness thresholds of US$300 and US$500 per QALY with an incremental cost?effectiveness ratio (ICER) of US$157 per QALY in the CD4 Conclusions: The REALITY enhanced?prophylaxis package in individuals with advanced HIV starting ART reduces morbidity and mortality, is practical to administer and is cost?effective. Efforts should continue to ensure that components are accessed at lowest available prices.

Background: The ongoing rollout of oral TDF-based PrEP has the potential to reduce HIV incidence in Sub-Saharan Africa (SSA) but HIV drug resistance (HIVDR) in PrEP breakthrough infections could threaten [...]

Introduction: Prevention of mother-to-child transmission (PMTCT) is a key strategy for ending the human immunodeficiency virus (HIV) pandemic. Most studies have focused on the mothers' side of the PMTCT cascade or the rate of vertical HIV transmission. Information on child-focused cascade is limited. We aimed to evaluate HIV testing, antiretroviral therapy (ART), and cotrimoxazole prophylaxis uptake and associated factors among HIV-exposed infants (HEIs) born in 2017. Methods: This was a record-based descriptive study in Mashonaland East Province, Zimbabwe. We analyzed routinely collected program data abstracted from electronic and paper-based HEI registers. Uptakes were calculated as proportions while associations were measured using adjusted risk ratios (log-binomial regression). Results: Of 1028 HEIs, 1015 (98.7%) were commenced on nevirapine prophylaxis, while 915 (89.0%) were commenced on cotrimoxazole prophylaxis. A total of 880 (85.0%) HEIs were tested for HIV by 6 weeks and 445 (44.4%) by 9 months. Overall, 40 (3.9%) were found to be HIV positive, and of them, 34 (85.0%) commenced on ART. Secondary and tertiary health facilities, being born through nonvaginal delivery, and certain districts were significantly associated with not commencing cotrimoxazole prophylaxis or getting tested for HIV. One district was associated with less risk of not having an HIV test by 9 months. Conclusions: While nevirapine, cotrimoxazole, and ART uptake were high among the HEIs, HIV testing by 9 months was suboptimal. The vertical HIV transmission rate was 3.9%. There is a need to strengthen HIV testing and antiretroviral and cotrimoxazole prophylaxes, especially at high-level facilities and certain districts.

Abstract Background Zimbabwe is among the 22 Tuberculosis (TB) high burden countries worldwide and runs a well-established, standardized recording and reporting system on case finding and treatment outcomes. During TB treatment, patients transfer-out and transfer-in to different health facilities, but there are few data from any national TB programmes about whether this process happens and if so to what extent. The aim of this study therefore was to describe the characteristics and outcomes of TB patients that transferred into Harare City health department clinics under the national TB programme. Specific objectives were to determine i) the proportion of a cohort of TB patients registered as transfer-in, ii) the characteristics and treatment outcomes of these transfer-in patients and iii) whether their treatment outcomes had been communicated back to their respective referral districts after completion of TB treatment. Methods Data were abstracted from patient files and district TB registers for all transfer-in TB patients registered from January to December 2010 within Harare City. Descriptive statistics were calculated. Results Of the 7,742 registered TB patients in 2010, 263 (3.5%) had transferred-in: 148 (56%) were males and overall median age was 33 years (IQR, 26–40). Most transfer-in patients (74%) came during the intensive phase of TB treatment, and 58% were from rural health-facilities. Of 176 patients with complete data on the time period between transfer-in and transfer-out, only 85 (48%) arrived for registration in Harare from referral districts within 1 week of being transferred-out. Transfer-in patients had 69% treatment success, but in 21% treatment outcome status was not evaluated. Overall, 3/212 (1.4%) transfer-in TB patients had their TB treatment outcomes reported back to their referral districts. Conclusion There is need to devise better strategies of following up TB patients to their referral Directly Observed Treatment (DOT) centres from TB diagnosing centres to ensure that they arrive promptly and on time. Recording and reporting of information must improve and this can be done through training and supervision. Use of mobile phones and other technology to communicate TB treatment outcomes back to the referral districts would seem the obvious way to move forward on these issues.

Abstract Background Provider-initiated HIV testing and counselling (PITC) is widely recommended to ensure timely treatment of HIV. The Zimbabwe Ministry of Health introduced PITC in 2007. We aimed to evaluate institutional capacity to implement PITC and investigate patient and health care worker (HCW) perceptions of the PITC programme. Methods Purposive selection of health care institutions was conducted among those providing PITC. Study procedures included 1) assessment of implementation procedures and institutional capacity using a semi-structured questionnaire; 2) in-depth interviews with patients who had been offered HIV testing to explore perceptions of PITC, 3) Focus group discussions with HCW to explore views on PITC. Qualitative data was analysed according to Framework Analysis. Results Sixteen health care institutions were selected (two central, two provincial, six district hospitals; and six primary care clinics). All institutions at least offered PITC in part. The main challenges which prevented optimum implementation were shortages of staff trained in PITC, HIV rapid testing and counselling; shortages of appropriate counselling space, and, at the time of assessment, shortages of HIV test kits. Both health care workers and patients embraced PITC because they had noticed that it had saved lives through early detection and treatment of HIV. Although health care workers reported an increase in workload as a result of PITC, they felt this was offset by the reduced number of HIV-related admissions and satisfaction of working with healthier clients. Conclusion PITC has been embraced by patients and health care workers as a life-saving intervention. There is need to address shortages in material, human and structural resources to ensure optimum implementation.

Abstract Background Zimbabwe is a Southern African country with a high HIV-TB burden and is ranked 19th among the 22 Tuberculosis high burden countries worldwide. Recurrent TB is an important problem for TB control, yet there is limited information about treatment outcomes in relation to HIV status. This study was therefore conducted in Chitungwiza, a high density dormitory town outside the capital city, to determine in adults registered with recurrent TB how treatment outcomes were affected by type of recurrence and HIV status. Methods Data were abstracted from the Chitungwiza district TB register for all 225 adult TB patients who had previously been on anti-TB treatment and who were registered as recurrent TB from January to December 2009. The Chi-square and Fischer's exact tests were used to establish associations between categorical variables. Multivariate relative risks for associations between the various TB treatment outcomes and HIV status, type of recurrent TB, sex and age were calculated using Poisson regression with robust error variance. Results Of 225 registered TB patients with recurrent TB, 159 (71%) were HIV tested, 135 (85%) were HIV-positive and 20 (15%) were known to be on antiretroviral treatment (ART). More females were HIV-tested (75/90, 83%) compared with males (84/135, 62%). There were 103 (46%) with relapse TB, 32 (14%) with treatment after default, and 90 (40%) with "retreatment other" TB. There was one failure patient. HIV-testing and HIV-positivity were similar between patients with different types of TB. Overall, treatment success was 73% with transfer-outs at 14% being the most common adverse outcome. TB treatment outcomes did not differ by HIV status. However those with relapse TB had better treatment success compared to "retreatment other" TB patients, (adjusted RR 0.81; 95% CI 0.68 - 0.97, p = 0.02). Conclusions No differences in treatment outcomes by HIV status were established in patients with recurrent TB. Important lessons from this study include increasing HIV testing uptake, a better understanding of what constitutes "retreatment other" TB, improved follow-up of true outcomes in patients who transfer-out and better recording practices related to HIV care and treatment especially for ART.

Introduction: Zimbabwe exclusively implemented targeted HIV testing until 2022 when Status-neutral testing was embraced. Whilst targeted testing aims to expand access and uptake of testing among high-risk individuals, status-neutral testing emphasizes post-test linkage to prevention and treatment services. To address how the two concepts relate in practice, we explored how status-neutral and targeted testing concepts correlate, in developing a double-edged strategy for effective case identification and linkage to prevention and treatment., Methods: We conducted a cross-sectional study on 36 multi-stage sampled sites across 4/10 provinces of Zimbabwe. A national screening algorithm was used to determine patient risk profiling and eligibility for testing. Screened-out patients were offered HIVST. Both screened and non-screened patients were tested and analysed for positivity ratios and linkage to post-test services. Epicollect5 was used to collect data and analysed using EpiData software and Stata. Univariate, bivariate and multivariate analyses were conducted at a 5% significance level., Results: Of 23,058 HIV tests done, females constituted 55% (n = 12,698), whilst 63.5% (n = 14,650) were retested. Through screening, at-risk patients contributed 75.1% to the overall positivity (1,296/1,727), from 66% (n = 15,289) of the total HIV tests conducted. All screened-out patients were non-reactive on HIVST: 1,182/1,182. 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). 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: The complementarity of the status-neutral and targeted testing approaches is evident from our results. By prioritizing high-risk individuals for testing and ensuring comprehensive linkage to both prevention and treatment services, these integrated strategies can effectively identify and manage people living with HIV. This combined approach optimizes resource use, particularly in low- and middle-income countries, and contributes to improved health outcomes and reduced HIV transmission rates., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Mugauri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: An individual's HIV risk, and consequently their HIV prevention needs, change over time. In this study we aimed to quantify these changes, examine which life-course events were associated with them, and investigate the extent to which those life-course events were associated with HIV acquisition., Methods: We used longitudinal data from eight rounds of a general population cohort in Manicaland province, eastern Zimbabwe, on sociodemographic and HIV risk behaviours, as well as HIV serostatus from the first seven rounds. We first visualised how HIV risk behaviours, comprised of having multiple, concurrent, non-regular, or transactional partners, condom non-use, drug use, and visiting bars, changed for individuals over time using Sankey diagrams. We then examined whether logistic regression models incorporating life-course events-namely, changes in marital or employment status, in-migration, or birth of a child-were more strongly associated with changes in HIV risk behaviour than models using only sociodemographic variables. Finally, we compared how well sociodemographic, HIV risk behaviour, and life-course events were associated with the person's risk of HIV acquisition as follows: we used logistic regression to identify which states (divided into sociodemographic, HIV risk behaviour, and life-course events) were most strongly associated with risk of HIV acquisition; based on this we use three models (corresponding to the three divisions) to identify the top 20% of individuals predicted to be at risk of acquiring HIV by each model, and computed what proportion of the actual HIV infection events occurred in that group., Findings: Between 1998 and 2021, 21 213 individuals were interviewed at least twice, contributing a total of 34 212 participant observations. In this setting, individuals had periods of HIV risk lasting less than 3 years; only 12·3% (102 of 831) of those reporting transactional sex had also reported this in the previous round. We found that life-course events such as changes in marital status, employment status, and in-migrant status were associated with these changes in HIV risk behaviour. Using life-course events, particularly ones related to changes in marital status, 23% and 30% more HIV acquisitions were identified than using HIV risk behaviours or sociodemographic information, respectively., Interpretation: HIV risk changes dynamically in this population, and life-course events could be a powerful way to understand changes in HIV risk behaviour and risk of HIV acquisition., Funding: Bill and Melinda Gates Foundation, UK Medical Research Council, and Department for International Development., Competing Interests: Declaration of interests SG declares shareholdings in GlaxoSmithKline and AstraZeneca. All other authors declare no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

HIV incidence is declining globally, but around half of all new infections are in sub-Saharan Africa-where adolescent girls and young women bear a disproportionate burden of new infections. Those who sell sex are at particularly high risk. Despite declining incidence rates and availability of effective biomedical prevention tools, we are not on track, globally or in Africa, to achieve UNAIDS 2025 prevention targets. For those at risk, interventions that strengthen their motivation, capabilities and access to all available HIV prevention technologies are critical-for adolescent girls and women in particular, but also for epidemic control more broadly. Exciting possibilities for scaling up new and highly effective prevention technologies are close, but delivery, implementation and financing models need to be developed and urgently evaluated, in partnership with communities, or these opportunities may be lost. Here, we discuss the evolving landscape of biomedical prevention technologies for women in Africa, their implementation and financing, as well as priorities for HIV prevention research in this setting., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. Springer Nature America, Inc.)

Background: Effective strategies to reduce sexually transmitted infection burden and transmission among female sex workers (FSWs) and their networks are needed. We report sexually transmitted infection prevalence among FSWs in Zimbabwe and investigate the performance of screening algorithms., Methods: Respondent-driven sampling (RDS) surveys, including blood sampling for syphilis serology, were conducted among FSWs in 3 communities in Zimbabwe in 2017. In addition, a random sample of one-third of participants were offered genital examination and sexually transmitted infection (STI) testing. Data on symptoms and clinical signs were analyzed to determine the proportion of asymptomatic and clinically inapparent STIs by HIV status, and the sensitivity, specificity, and predictive values of syndromic, clinical, and hybrid screening algorithms for chlamydia and gonorrhea. Analyses were RDS-II weighted., Results: Overall, 2507 women were included in the RDS surveys, and 661 of 836 (79.1%) of those randomly offered genital examination and STI testing accepted. The prevalence of STI by site ranged from 15.7% to 20.0% for syphilis (rapid plasma reagin + Treponema pallidum hemagglutination assay), 6.8% to 14.3% for gonorrhea, 8.4% to 10.1% for chlamydia, 26.6% to 35.5% for trichomonas, and 37.0% to 47.6% for any high-risk human papilloma virus. A high proportion of infections were both asymptomatic and clinically undetectable (gonorrhea: 41.2%, chlamydia: 51.7%, trichomonas: 62.8%). Screening algorithms performed poorly whether based on symptoms only (sensitivity: 53.3% gonorrhea, 43.3% chlamydia) or either symptoms or clinical signs (sensitivity: 58.7% gonorrhea, 48.3% chlamydia)., Conclusions: Sexually transmitted infection burden is high among FSWs in Zimbabwe. The low sensitivity and specificity of screening algorithms used to guide syndromic management mean that more effective approaches are required to strengthen STI control. As access to HIV-specific prevention methods like preexposure prophylaxis increases, support for consistent condom use needs to be strengthened., Competing Interests: Conflict of Interest and Sources of Funding: This research was funded in whole or in part by the President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of grant no. 1U2GPS003118-05-03 between CDC and RTI to support the implementation of the Building Health Data Dissemination and Information Use Systems in the Republic of Zimbabwe under the President's Emergency Place for AIDS Relief Activities, and by the Wellcome Trust (grant no. 214280/Z/18/Z). The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Sexually Transmitted Diseases Association.)

Background: Young people are at particularly high risk of acquiring sexually transmitted infections (STIs). We conducted a trial to investigate the effect of a community-based intervention that included STI screening among youth on population-level prevalence of STIs in Zimbabwe., Methods: STICH was a parallel-arm, cluster-randomised controlled trial nested within CHIEDZA, a trial of community-based integrated HIV and sexual and reproductive health services for youth in Zimbabwe. STICH was conducted in Harare and Bulawayo provinces with eight clusters in each province, randomised 1:1 to control (existing health services) or to the intervention: community-based screening and treatment for Chlamydia trachomatis and Neisseria gonorrhoeae (males and females) and Trichomonas vaginalis (females only) offered over 12 months to intervention cluster residents aged 16-24 years who were attending CHIEDZA. Outcomes were ascertained through a population-level survey immediately after the intervention period, which included young people aged 18-24 years who lived in randomly selected households in each of the 16 clusters. The primary outcome was population prevalence of any (one or more) of the three STIs; secondary outcomes were prevalence of each of the three STIs. The STICH trial is registered with ISRCTN registry, ISRCTN15013425, and the CHIEDZA trial is registered with ClinicalTrials.gov, NCT03719521., Findings: From Oct 6, 2021, to March 8, 2022, 6361 randomly sampled young people were recruited into the outcome survey (median age 20 years [IQR 19-22], 3500 female and 2101 male, 3066 in intervention clusters and 3295 in control clusters). 5601 participants were included in the primary outcome analysis (2756 in intervention clusters and 2845 in control clusters). In the intervention clusters, 612 (22·2%) of 2756 participants reported that they had attended CHIEDZA and 298 (10·8%) had been tested for C trachomatis and N gonorrhoeae. In the control clusters, 113 (4·0%) of 2845 participants had attended CHIEDZA and 40 (1·4%) had been tested for C trachomatis and N gonorrhoeae. In the outcome survey, the cluster-level geometric mean prevalence of the primary outcome (any of C trachomatis, N gonorrhoeae, and T vaginalis) was 19·07% (geometric standard deviation [GSD] 1·20) in the intervention arm versus 19·95% (GSD 1·10) in the control arm (risk ratio [RR] 0·93 [95% CI 0·78-1·10]; p=0·35). There was no difference between arms in geometric mean prevalence of C trachomatis (12·86% [GSD 1·14] in the intervention arm vs 12·94% [GSD 1·15] in the control arm, RR 0·97 [95% CI 0·84-1·11]; p=0·60) or T vaginalis (7·06% [GSD 1·48] vs 6·20% [1·38], RR 1·09 [95% CI 0·74-1·60]; p=0·66). N gonorrhoeae prevalence was significantly lower in the intervention arm, with a 43% risk reduction (geometric mean 1·65% [GSD 1·77] vs 2·87% [1·43], RR 0·57 [95% CI 0·34-0·96]; p=0·036)., Interpretation: Our study showed high population prevalence of curable STIs. Community-based STI screening appeared to reduce population-level prevalence of N gonorrhoeae, but not of C trachomatis or T vaginalis, probably due to low intervention coverage. Future research is needed on the effects of screening interventions on morbidity, antimicrobial resistance, and re-infection rates., Funding: Medical Research Council, Economic and Social Research Council, Department for International Development, National Institute for Health and Care Research, and the Wellcome Trust., Competing Interests: Declaration of interests KM has received funding from FIND to validate a novel lateral flow assay for gonorrhoea and a loan of a GeneXpert Machine. KM is also the recipient of a Wellcome Trust grant for a clinical PhD fellowship assessing point-of-care testing for STIs (Grant number 225468/Z/22/Z). All other authors declare no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Introduction: In the context of key population HIV testing programmes, identifying new HIV acquisitions, tracking incidence, and responding with prevention and treatment interventions will be critical for achieving HIV epidemic control. Laboratory tests for recently acquired HIV used as part of a "recent infection testing algorithm" (RITA), offer a potential tool to support this work. We implemented a RITA for female sex workers (FSWs) in Zimbabwe to explore opportunities and programmatic benefits., Methods: Between October 2021 and January 2023, recency testing was offered to FSWs attending the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe's key populations programme. Dried blood spot (DBS) samples were taken at 86 clinic sites across 10 provinces and Laboratory LAg Avidity and viral load testing conducted. RITA results were analysed and linked to programme data to explore geographical differences and calculate HIV incidence. We describe concurrent efforts in HIV testing for social (social network testing [SNT]) and sexual (index case testing [ICT]) contacts of those testing HIV positive., Results: Among 24,976 FSWs tested at programme sites, 9.5% (2363/24,976) were confirmed HIV positive. We enrolled 55.5% (1311/2363) of eligible HIV-positive FSWs to our study, of whom 11.7% (153/1311) were identified as having recently acquired HIV. It took a median of 37 days (IQR 20-67) for samples to be processed. Enrolment rates varied between provinces but the proportion of recently acquired HIV was similar (range: 18.4% to 4.0%). Overall HIV incidence was 3.4 (95% CI 2.7-4.0) per 100py. Where results could be linked to routinely collected data, we found no evidence of a difference in test-positivity between the ICT and SNT contacts of those with recently acquired compared to those with long-term HIV., Conclusions: Implementation of a RITA was possible within a nationally scaled sex worker programme, and while challenging to implement, can provide an understanding of transmission dynamics and HIV incidence in this context. Sub-optimal recruitment and data linkage limited the interpretation of our findings and opportunities for strategic gains though focusing on HIV prevention efforts., (© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)

Background: Early experiences of sexual violence may influence HIV care and treatment outcomes among women living with HIV (WLHIV). We examined whether self-report by WLHIV of being forced into their first sexual experience was associated with awareness of HIV-positive status, being on antiretroviral therapy (ART) and being virologically suppressed., Setting: We conducted a secondary analysis using nationally representative, cross-sectional Population-based HIV Impact Assessment surveys from Lesotho, Malawi, Zambia, and Zimbabwe conducted from 2015 through 2017., Methods: Adjusted logistic regression models with survey weights and Taylor series linearization were used to measure the association between forced first sex and 3 HIV outcomes: (1) knowledge of HIV status among all WLHIV, (2) being on ART among WLHIV with known status, and (3) virological suppression among WLHIV on ART., Results: Among WLHIV, 13.9% reported forced first sex. Odds of knowledge of HIV status were not different for WLHIV with forced first sex compared with those without (adjusted odds ratio [aOR], 1.17; 95% CI: 0.95 to 1.45). Women living with HIV with forced first sex had significantly lower odds of being on ART (aOR 0.74, 95% CI: 0.57 to 0.96) but did not have lower odds of virological suppression (aOR 1.06, 95% CI: 0.80 to 1.42) compared with WLHIV without forced first sex., Conclusions: While high proportions of WLHIV were on ART, report of nonconsensual first sex was associated with a lower likelihood of being on ART which may suggest that early life trauma could influence long-term health outcomes., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Men who have sex with men (MSM) are disproportionately impacted by HIV in sub-Saharan Africa (SSA), where condomless anal intercourse (CAI) is a major driver of HIV transmission among this hidden subpopulation., Objectives: To determine CAI drivers and prevalence among HIV-positive and HIV-negative MSM., Method: Data from 1538 MSM who participated in a biobehavioural survey in Zimbabwe were used. Secondary statistical data analysis methods were used to determine prevalences and drivers of CAI., Results: A high prevalence of CAI, of at least 30%, among HIV-positive and HIV-negative MSM was found. Factors that led to a statistically significant higher CAI among HIV-positives compared to HIV-negatives included drunkenness (35% vs. 25%, P = 0.01), fear of partner (13% vs. 9%, P = 0.017), trusting the partner (10% vs. 6%, P = 0.008), and being offered more money (10% vs. 6%, P = 0.003)., Conclusion: Our findings indicate that economic, socio-behavioural and perceptual dimensions increase men's likelihood to engage in risky sexual behaviour, suggesting the need for HIV prevention efforts that provide tailored education regarding HIV risk among MSM in SSA. This is the first large biobehavioural survey that generated valuable information useful for analysing condomless anal sex among MSM in Zimbabwe., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)