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Peer-reviewedCC BY 4.0PLOS Medicine

HIV diagnosis and treatment status in individuals dying from HIV in Zimbabwe, Malawi, and South Africa: A model comparison analysis

  • Loveleen Bansi-Matharu1
  • Daniel T. Citron2
  • Rowan Martin-Hughes3
  • Haroon Moolla4
  • John Stover5
  • Michael Pickles6
  • Tara Mangal7
  • Jenny Smith8
  • Owen Mugurungi9
  • Mmatlou Simeon Kubyana10
  • Isaac Taramusi11
  • Valentina Cambiano12
10 more authors
  • Amon Mpofu13
  • Debra ten Brink14
  • Edinah Mudimu15
  • Tsitsi Apollo
  • Anna Bershteyn
  • Linley Chewere
  • Dobromir Dimitrov
  • Stephen Macheso
  • Leigh F. Johnson
  • Andrew Phillips
15 affiliations
  1. 1Institute for Global Health, UCL, London, United Kingdom
  2. 2Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
  3. 3Burnet Institute, Melbourne, Australia
  4. 4Centre for Integrated Data and Epidemiological Research, University of Cape Town, Cape Town, South Africa
  5. 5Avenir Health, Takoma Park, Maryland, United States of America
  6. 6MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, United Kingdom
  7. 7Centre for Health Economics, University of York, York, United Kingdom
  8. 8Ministry of Health & Child Welfare, Harare, Zimbabwe
  9. 9Department of Decision Sciences, University of South Africa, Pretoria, South Africa
  10. 10UNAIDS UCO, Harare, Zimbabwe
  11. 11National AIDS Council, Harare, Zimbabwe
  12. 12Ministry of Health and Child Care, HIV Program, Harare, Zimbabwe
  13. 13Department of HIV, STI & Hepatitis, Ministry of Health, Lilongwe, Malawi
  14. 14Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
  15. 15UNICEF Country Office, Lilongwe, Malawi (SM)
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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.

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Cite

BibTeXRIS
BibTeX
@article{bansimatharu2026diagnosis,
  title = {{HIV diagnosis and treatment status in individuals dying from HIV in Zimbabwe, Malawi, and South Africa: A model comparison analysis}},
  author = {Loveleen Bansi-Matharu and Daniel T. Citron and Rowan Martin-Hughes and Haroon Moolla and John Stover and Michael Pickles and Tara Mangal and Jenny Smith and Owen Mugurungi and Mmatlou Simeon Kubyana and Isaac Taramusi and Valentina Cambiano and Amon Mpofu and Debra ten Brink and Edinah Mudimu and Tsitsi Apollo and Anna Bershteyn and Linley Chewere and Dobromir Dimitrov and Stephen Macheso and Leigh F. Johnson and Andrew Phillips},
  journal = {PLOS Medicine},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pmed.1004864},
  url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004864},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - HIV diagnosis and treatment status in individuals dying from HIV in Zimbabwe, Malawi, and South Africa: A model comparison analysis
AU  - Loveleen Bansi-Matharu
AU  - Daniel T. Citron
AU  - Rowan Martin-Hughes
AU  - Haroon Moolla
AU  - John Stover
AU  - Michael Pickles
AU  - Tara Mangal
AU  - Jenny Smith
AU  - Owen Mugurungi
AU  - Mmatlou Simeon Kubyana
AU  - Isaac Taramusi
AU  - Valentina Cambiano
AU  - Amon Mpofu
AU  - Debra ten Brink
AU  - Edinah Mudimu
AU  - Tsitsi Apollo
AU  - Anna Bershteyn
AU  - Linley Chewere
AU  - Dobromir Dimitrov
AU  - Stephen Macheso
AU  - Leigh F. Johnson
AU  - Andrew Phillips
PY  - 2026
DA  - 2026/09/10
JO  - PLOS Medicine
DO  - 10.1371/journal.pmed.1004864
UR  - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004864
AB  - 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.
SN  - 1549-1676
ER  -