Poverty and protection: the relationship between multidimensional poverty, social protection interventions, and HIV...

Social protection can mitigate poverty's effects on HIV, but program implementation may influence impact. We explored relationships between multidimensional poverty, social protection programming, and HIV viral load among an adult population with HIV (PWH) in Zimbabwe.

A sequential explanatory mixed methods study.

We analyzed retrospective cross-sectional data from client satisfaction surveys collected between January and July 2023 among adult PWH receiving care in 15 districts of Zimbabwe. We employed descriptive analyses, generalized estimated equations, and moderation analyses to evaluate relationships between multidimensional poverty, social protection, and viral load nonsuppression. Between August and September 2023, we conducted semi-structured in-depth interviews (IDIs) with adults regarding access to tuberculosis care and social protection interventions. We applied the Exploration, Preparation, Implementation, and Sustainment framework for qualitative analysis and integrated results at the interpretation phase.

Among 13 722 PWH [65.4% women, median age 44 years (interquartile range: 36-52)], 44.4% were multidimensionally poor. Only 18% had ever received social protection. Poverty was associated with viral load nonsuppression [adjusted prevalence ratio (aPR) = 1.55; 95% confidence interval (CI): 1.13-2.13], as was social protection receipt [aPR = 1.67; 95% CI: 1.07-2.62)]. IDIs showed that PWH experienced significant impoverishment, had little information about and access to social protection, and reported limited quantities and durations of receipt.

We observed a high burden of poverty and tenuous access to social protection. Multidimensional poverty was associated with virologic nonsuppression, as was social protection receipt, which may signal significant vulnerability in our population and inadequacy of social protection coverage and responsiveness.