Manicaland HIV Project

The Manicaland Centre for Public Health Research studies the spread, impact, and control of HIV in eastern Zimbabwe. BRTI hosts the centre’s work in-country. The centre has published more than 200 scientific papers, most of them open access. Its own site is manicalandhivproject.org.

Open cohort

The centre runs a population-based open cohort in 12 sites that represent four socio-economic strata in Manicaland. Between 1998 and 2013 it completed six rounds of data collection among adults aged 15 to 54. The fifth and sixth rounds also measured HIV prevalence, incidence, and mortality among about 3,000 children aged 2 to 14.

Each round begins with a census of households in the study sites, then individual interviews and HIV testing. Caregivers of participants who have died are interviewed for a verbal autopsy. Women attending antenatal clinics give dried blood spots for HIV testing. Because the communities are dispersed, each round is enumerated in phases and takes 18 to 24 months.

The questionnaires cover migration, socio-demographic and socio-economic characteristics, mortality and fertility, orphanhood, sexual behaviour and its social determinants, knowledge of HIV, and access, uptake, and adherence to treatment and other services. Questions are kept as consistent as possible across rounds so trends can be measured, and are updated when testing and treatment services change.

Alongside the general-population cohort, each round includes unlinked anonymous HIV surveillance among pregnant women at local antenatal clinics, using procedures similar to national surveillance. That comparison shows how antenatal estimates relate to prevalence in the general population, and how the bias changes over time. The cohort has been funded primarily by the Wellcome Trust, with support from the Bill & Melinda Gates Foundation.

Other studies at the centre

HIV prevention cascades. The centre is developing survey methods to measure and interpret prevention cascades for the methods and risk groups that matter most at population level. Funded by the Bill & Melinda Gates Foundation.

Youth HIV prevention. This work uses behavioural economics and community psychology to understand why young women and their male partners do or do not use prevention, and to test approaches that could be taken to scale. Funded by the U.S. National Institutes of Health.

Rapid HIV testing. Nurse-administered rapid tests are compared with carefully controlled ELISA results from a central laboratory. A mathematical model estimates the epidemiological and health-service impact of misclassification, and the findings are discussed with stakeholders to set acceptability thresholds and quality-assurance responses. Funded by the Bill & Melinda Gates Foundation.

Treatment policy. The centre studies how guidelines such as test-and-treat reach facilities and are put into practice across HIV testing, pre-ART care, and ART services, following the 2016 World Health Organization and national guidelines. Funded by the Wellcome Trust.

COVID-19 and HIV risk. A study of how the pandemic and the government response affected HIV prevention in the Manicaland study population. Funded by the Bill & Melinda Gates Foundation.

The centre has run studies grounded in Manicaland since 1993, and closes or adapts projects as the questions in the epidemic change.