Published in PLOS One on 2026-03-25, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Juliet Gamuchirai Nyamasve, Carren Pindiriri, Tonderai Mapako, Alex Ingwani, Shevone Corbin, Owen Mugurungi, Tsitsi Apollo, Shepherd Chikomo, Kundai Chikambure, Shepherd Shamu, Linden Morrison, Nokuthula Mujuru, Emmanuel Boadi, Tatjana Peterson, Joconiah Chirenda
Source: PLOS One • DOI 10.1371/journal.pone.0345316
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Although ART has transformed HIV into a manageable chronic condition, significant cost and logistical challenges persist, threatening progress toward the UNAIDS 95-95-95 targets. Budget allocation to the health sector declined by over 30% in the last decade in Zimbabwe, attributed to donor fatigue and emergence of pandemics. The time-driven activity-based costing (TDABC) method was used to estimate the provider costs of ART and inform resource allocation for sustained ART programming. A descriptive cross-sectional study in 11 facilities across Zimbabwe’s four levels of care collected data using standardized instruments, capturing over 2,500 provider-recipient observations. Process maps of HIV care pathways were developed with subject matter experts to document resource use and standard of care. Time taken to deliver ART services, cost of space and cost of equipment were used to calculate costs and validated by national level stakeholders. In 2022, annual provider costs for ART in totalled $168.66 million for 1.2 million patients. National costs are projected to $192.44 million by 2026, attributed to declining HIV-related mortality and incidence. Primary care facilities bore 75% of costs due to higher patient volume. Provider costs averaged $57.05 for adult ART initiation and $62.70 for paediatric initiation. First-year ART costs per client were $252.78 (adult) and $450.56 (paediatric). Annual maintenance costs were $138.93 for first-line and $174.93 for second-line ART. Laboratory services ($30.72) contributed more to adult ART costs than medicines ($27.98). ART costs exceeded prior estimates, driven by facility-level differences, laboratory expenses, and paediatric formulations. Task-shifting proved cost-efficient, but sustainability is threatened by funding gaps and low health worker compensation. Optimizing laboratory systems and decentralizing services remain critical. External funding withdrawal created an annual gap of more than $50 million. Sustaining ART to 2030, requires improving domestic resource mobilization, strengthening ART decentralization, and designing cost-efficient laboratory models that preserve treatment quality.
Introduction
Globally, HIV infection has long been a pressing public health concern with over 39 million recorded cases [1]. Sub-Saharan Africa represents the epidemic’s epicenter, housing over two-thirds of all HIV cases, with women and girls disproportionately affected. The HIV treatment landscape has transitioned from a global catastrophe to a manageable chronic condition as shown by the global decline in the HIV incidence from 0.06% down to 0.019% and in Zimbabwe from 0.48% to 0.21% from 2011 to 2021 respectively. Improved access to ART, HIV prevention activities, HIV care and support services, has increased survival rates among people living with HIV and reduced HIV-related mortality, with an estimated 59,573 deaths averted in Zimbabwe in 2022 alone [2].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Juliet Gamuchirai Nyamasve, Carren Pindiriri, Tonderai Mapako, Alex Ingwani, Shevone Corbin, Owen Mugurungi, Tsitsi Apollo, Shepherd Chikomo, Kundai Chikambure, Shepherd Shamu, Linden Morrison, Nokuthula Mujuru, Emmanuel Boadi, Tatjana Peterson, Joconiah Chirenda. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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