{ "abstract": "Background: Antiretroviral therapy (ART) has greatly reduced HIV-related mortality and improved life expectancy in sub-Saharan Africa since the early 2000s. However, HIV-related mortality remains high. To guide intervention priorities, we used seven established HIV simulation models to identify where in the HIV care cascade deaths occur in Zimbabwe, Malawi, and South Africa. This multi-model approach provided a more comprehensive and robust assessment than could be achieved using any single modelling approach. Methods and findings: To assess alignment, each model generated key HIV metrics from 2000 to 2045, including total population, HIV prevalence, annual new infections, and proportions of people with HIV (PWH) who were diagnosed, on ART, and virally suppressed. HIV-related deaths were estimated annually and categorised by whether they occurred in individuals who were (1) undiagnosed, (2) diagnosed but had not yet started ART, (3) on ART, or (4) had interrupted ART. Conclusion: Absolute numbers of HIV-related deaths vary substantially between models, highlighting wider issues around ascertainment of death in the region. However, our results do consistently show that most deaths are occurring amongst PWH on ART in Zimbabwe and Malawi, and amongst those who have interrupted treatment in South Africa, suggesting interventions around adherence counselling and retention in care need to be prioritised. Why was this study done?: What did the researchers do and find?: What do these findings mean?: In a comparison of seven HIV simulation models, Loveleen Bansi-Matharu and colleagues identify distinct points in the HIV care cascade where deaths occur in people with HIV in Zimbabwe, Malawi and South Africa, suggesting adherence and retention in care are key targets for intervention.", "abstract_shown": true, "affiliations": [ "Institute for Global Health, UCL, London, United Kingdom", "Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America", "Burnet Institute, Melbourne, Australia", "Centre for Integrated Data and Epidemiological Research, University of Cape Town, Cape Town, South Africa", "Avenir Health, Takoma Park, Maryland, United States of America", "MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, United Kingdom", "Centre for Health Economics, University of York, York, United Kingdom", "Ministry of Health & Child Welfare, Harare, Zimbabwe", "Department of Decision Sciences, University of South Africa, Pretoria, South Africa", "UNAIDS UCO, Harare, Zimbabwe", "National AIDS Council, Harare, Zimbabwe", "Ministry of Health and Child Care, HIV Program, Harare, Zimbabwe", "Department of HIV, STI & Hepatitis, Ministry of Health, Lilongwe, Malawi", "Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America", "UNICEF Country Office, Lilongwe, Malawi (SM)" ], "article_type": "Research Article", "arxiv": null, "author_total": 22, "authors": [ { "affs": [ 0 ], "name": "Loveleen Bansi-Matharu" }, { "affs": [ 1 ], "name": "Daniel T. Citron" }, { "affs": [ 2 ], "name": "Rowan Martin-Hughes" }, { "affs": [ 3 ], "name": "Haroon Moolla" }, { "affs": [ 4 ], "name": "John Stover" }, { "affs": [ 5 ], "name": "Michael Pickles" }, { "affs": [ 6 ], "name": "Tara Mangal" }, { "affs": [ 7 ], "name": "Jenny Smith" }, { "affs": [ 8 ], "name": "Owen Mugurungi" }, { "affs": [ 9 ], "name": "Mmatlou Simeon Kubyana" }, { "affs": [ 10 ], "name": "Isaac Taramusi" }, { "affs": [ 11 ], "name": "Valentina Cambiano" }, { "affs": [ 12 ], "name": "Amon Mpofu" }, { "affs": [ 13 ], "name": "Debra ten Brink" }, { "affs": [ 14 ], "name": "Edinah Mudimu" }, { "name": "Tsitsi Apollo" }, { "name": "Anna Bershteyn" }, { "name": "Linley Chewere" }, { "name": "Dobromir Dimitrov" }, { "name": "Stephen Macheso" }, { "name": "Leigh F. Johnson" }, { "name": "Andrew Phillips" } ], "bibtex": "https://research.draconitic.com/paper/arysqwk854pp9.bib", "cited_by": 0, "doi": "10.1371/journal.pmed.1004864", "fulltext_url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004864", "id": "arysqwk854pp9", "issns": [ "1549-1676" ], "landing_url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004864", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2725|HIV/AIDS Research and Interventions" ], [ "plos", "/Biology and life sciences/Immunology/Vaccination and immunization/Antiviral therapy/Antiretroviral therapy" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/RNA viruses/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Population biology/Population metrics/Death rates" ], [ "plos", "/Medicine and health sciences/Diagnostic medicine/HIV diagnosis and management" ], [ "plos", "/Medicine and health sciences/Epidemiology/HIV epidemiology" ], [ "plos", "/Medicine and health sciences/Immunology/Vaccination and immunization/Antiviral therapy/Antiretroviral therapy" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Preventive medicine/Vaccination and immunization/Antiviral therapy/Antiretroviral therapy" ], [ "plos", "/People and places/Geographical locations/Africa/Malawi" ], [ "plos", "/People and places/Geographical locations/Africa/South Africa" ], [ "plos", "/People and places/Geographical locations/Africa/Zimbabwe" ] ], "openalex": "W7212157984", "pdf_url": "https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1004864&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-10", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/arysqwk854pp9.ris", "sources": [ { "first_seen": "2026-10-30T12:17:56Z", "native_id": "10.1371/journal.pmed.1004864", "source": "plos", "url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004864" } ], "subjects": [ { "field": "biology", "origin": "plos:immunology", "subfield": "immunology" }, { "field": "biology", "origin": "plos:microbiology", "subfield": "microbiology" }, { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" } ], "title": "HIV diagnosis and treatment status in individuals dying from HIV in Zimbabwe, Malawi, and South Africa: A model comparison analysis", "title_text": "HIV diagnosis and treatment status in individuals dying from HIV in Zimbabwe, Malawi, and South Africa: A model comparison analysis", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:56Z", "url": "https://research.draconitic.com/paper/arysqwk854pp9", "venue": "PLOS Medicine", "versions": [] }