SUMMARY SHEET | DECEMBER 2022

MOZAMBIQUE
POPULATION-BASED HIV IMPACT ASSESSMENT
INSIDA 2021

The Mozambique Population-based HIV Impact Assessment (PHIA), INSIDA 2021 was led by the Government of Mozambique through the
INSIDA 2021 was a household-based national survey conducted between National Institute of Health (INS), in collaboration with the Ministry
April 2021 and February 2022 to measure the impact of the country’s of Health (MISAU), the National AIDS Council (CNCS), and the
national and provincial HIV response. INSIDA 2021 included adults, National Institute of Statistics (INE). The survey was conducted with
defined as those aged 15 years and older, offered HIV counseling and funding from the United States (US) President’s Emergency Plan for
testing with return of results and collected information about uptake of AIDS Relief (PEPFAR) with technical assistance from the US Centers
HIV care and treatment services. In addition, the survey estimated national for Disease Control and Prevention (CDC), and ICAP at Columbia
HIV incidence as well as the national and provincial HIV prevalence among University. The implementation of INSIDA 2021 also included support
adults and the prevalence of viral load suppression (VLS), defined as HIV from the Government of Mozambique and from the Provincial and
RNA <1,000 copies per milliliter among adults living with HIV. The results District Health Services and Directorates, Health Units, and local and
of INSIDA 2021 provide information on national and provincial progress community authorities. The Government of Mozambique and national
toward control of the HIV epidemic. and international development partners participated in the National
Executive Committee and Technical Working Groups during the survey
development and implementation.

KEY FINDINGS

Annual incidence of HIV among adults (aged 15 years and older) in Mozambique was 0.43%. HIV incidence was 0.61% among women and
0.24% among men.
Prevalence of HIV among adults in Mozambique was 12.5%, which corresponds to approximately 2,097,000 adults living with HIV. Prevalence
of HIV was higher among women (15.0%) than among men (9.5%).
Prevalence of VLS among adults living with HIV in Mozambique was 64.1%: 67.1% among women and 58.8% among men. Note, these
estimates of VLS are among all adults living with HIV regardless of their knowledge of HIV status or use of antiretroviral therapy (ART).

See ins.gov.mz or phia.icap.columbia.edu for more details.

The mark “CDC” is owned by the U.S. Dept. of Health and Human Services and is used with permission. Use of this logo is not an endorsement by HHS or CDC of any particular product, service, or enterprise.
This project is supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR) through CDC under the terms of cooperative agreement #U2GGH002173. The findings and conclusions are those of the authors and
do not necessarily represent the official position of the funding agencies. The results presented here should be considered preliminary and are subject to change.
 SUMMARY SHEET | DECEMBER 2022

HIV PREVALENCE AMONG ADULTS

HIV PREVALENCE,
by AGE and SEX

Among women, HIV prevalence ranged

from 4.5% in those aged 15-19 years
up to 26.6% in those aged 35-39 years.
Among men, it varied from 1.6% among
those aged 15-19 years up to 19.6%
among those aged 40-44 years.

HIV prevalence was two to three times

as high among women as among men
in the age groups between 15-29 years.

Error bars represent 95% CIs.

HIV PREVALENCE, by PROVINCE

HIV prevalence among adults aged 15 years and older ranged from 7.9% in Manica up to 20.9% in Gaza. HIV prevalence in Maputo Província (15.4%),
Maputo Cidade (16.2%), Zambézia, (17.1%), and Gaza (20.9%) was markedly higher than in Manica (7.9%), Niassa (8.0%), Tete (8.4%), Nampula (10.0%).
 SUMMARY SHEET | DECEMBER 2022

VIRAL LOAD SUPPRESSION AMONG ADULTS LIVING WITH HIV

VIRAL LOAD SUPPRESSION, by

AGE and SEX

Among adults (ages 15 years and older)

living with HIV in Mozambique, VLS
prevalence varied by age. Among women,
the prevalence of VLS ranged from 45.2%
among those aged 15-24 years up to 77.6%
among those aged 45-54 years.

Among men, less than half of those

aged 15-24 years and 25-34 years had
suppressed viral loads (42.4% and 43.3%,
respectively). VLS prevalence peaked at
88.2%* among those 65 years and older.

In the age group 25-34 years, men had

a substantially lower rate of viral load
suppression when compared to women.

* Please note the estimate was based on between 25 and 49

survey participants and should be interpreted with caution.

Error bars represent 95% Cls.

Estimates based on a denominator between 25 and 49 are included in parentheses and should be interpreted with caution.

VIRAL LOAD SUPPRESSION AMONG ADULTS LIVING WITH HIV, by PROVINCE

The prevalence of VLS varied considerably from a low of 42.5% in Cabo Delgado to a peak of 80.3% in Gaza. The VLS prevalence in Cabo Delgado
(42.5%), Nampula (47.9%), and Sofala (51.4%) were substantially lower compared to the prevalence in Maputo Cidade (69.3%), Manica (71.8%),
Zambézia (74.5%), Maputo Província (76.0%), and Gaza (80.3%).

VLS=viral load suppression.

 SUMMARY SHEET | DECEMBER 2022

ACHIEVEMENT OF THE 95-95-95 TARGETS AMONG ADULTS LIVING WITH HIV

95-95-95: Treatment targets to help end the HIV epidemic

The Joint United Nations Programme on HIV/AIDS (UNAIDS) set the 95-95-95 targets with the aim that by 2025, 95% of all people living with HIV
will know their HIV status; 95% of all people diagnosed with HIV will receive sustained ART; and 95% of all people receiving ART will have VLS.

ACHIEVEMENT OF THE 95-95-95 TARGETS, by SEX

Diagnosed: In Mozambique, 71.6% of

adults (aged 15 years and older) living
with HIV were aware of their HIV-positive
status: 73.3% of women and 68.5% of men.
Individuals were classified as aware if they
reported their HIV-positive status or had a
detectable antiretroviral (ARV) in their blood.
On Treatment: Among adults living with
HIV who were aware of their positive
status, 96.4% were on ART: 97.5% of
women and 94.3% of men. Individuals
were classified as being on ART if they
reported current ART use or had a
detectable ARV in their blood.
Viral Load Suppression: Among adults who
were on ART, 89.4% had suppressed viral
loads: 90.4% of women and 87.6% of men.

Percentages shown in the graph refer to the conditional 95-95-95 targets described in the text above and to the right.
The heights of the bars represent the unconditional (overall) percentages for each indicator among all people living with HIV.
Error bars represent 95% CIs.

CONCLUSIONS

• One out of eight adults in Mozambique are living with HIV —which represents a substantial challenge for the country’s health system. These
results demonstrate the need to strengthen the implementation of HIV prevention measures to reduce the number of new infections.
• There are marked differences in HIV prevalence at the provincial level, as well as by age and sex.
• Achieving VLS is a challenge in almost all age groups for both sexes, especially among women aged 15 to 24 years and men aged 15 to 34 years. In
addition, the data show substantial provincial variability with respect to VLS. These results offer the opportunity for greater focus on support for
HIV and treatment literacy, adherence support, monitoring for drug resistance, and other strategies to improve viral load suppression.
• With regards to the 95-95-95 targets, Mozambique has already reached the 95% treatment target for people living with HIV who know their
status; however continued efforts are needed to reach the targets for awareness of HIV status and VLS.

RESPONSE RATES AND HIV TESTING METHODS

Of 8,998 eligible households, 96.5% completed a household interview. Among 19,912 eligible adults (11,098 women and 8,814 men), 14,488 (8,255
women and 6,233 men) were interviewed and tested for HIV. When accounting for enumeration area and dwelling unit response, 96.3% and 88.0%
respectively, the overall response rate for adults was 59.5%: 60.8% for women and 57.8% for men.

HIV prevalence testing was conducted in each household using a serological rapid diagnostic testing algorithm based on Mozambique’s national
guidelines, with laboratory confirmation of seropositive samples using a supplemental assay. For confirmed HIV-positive samples, laboratory-based
testing was conducted for quantitative evaluation of viral load and qualitative detection of ARVs (atazanavir, lopinavir, efavirenz, and dolutegravir).
A laboratory-based incidence testing algorithm (HIV-1 limiting antigen-avidity assay with correction for viral load and detectable ARVs) was used to
distinguish recent from long-term infection. Incidence estimates were obtained using the formula recommended by the World Health Organization
Incidence Working Group and Consortium for Evaluation and Performance of Incidence Assays. Survey weights were utilized for all estimates.