Background Zimbabwe has experienced one of the world’s most severe HIV crises since the first reported case of AIDS in the country in 1985. Over the last decade, the Zimbabwe Government has implemented a range of services to prevent new infections and to support people living with HIV, e.g. HIV testing and counselling (HTC), anti-retroviral treatment (ART), prevention of mother-to-child transmission (PMTCT), and male circumcision (MC).

We describe trends and patterns in knowledge and uptake of these services, investigate individual-level factors associated with greater levels of coverage, and analyse shortfalls in order to inform future policies on the scale-up of HIV services.

Methods Data from the latest round of a large (n≈12,000) population-based cohort study conducted between 2009 and 2011 in eastern Zimbabwe will be used in logistic regression models to analyse associations between demographic, socio-economic, behavioural and other factors, and knowledge and uptake of services. Temporal trends in uptake of services will be measured using data from earlier rounds of the study.

Results HIV prevalence in the general population of Manicaland province remained comparably high (15.1%; 95% confidence interval: 14.5%–15.7%). Preliminary univariate results suggest that knowledge of HIV services was high for HTC (82.3%; 91.6%–82.9%) and PMTCT (93.0%; 92.0%–93.9%). Knowledge of ART was low overall (40.1%; 39.3%–40.9%) but high in self-reported HIV-positives (88.9%; 86.8%–90.7%). Overall uptake of services in the last three years was moderate for HTC (44.0%; 43.2%–44.8%) and PMTCT (65.2%; 57.1%–72.6%). Current uptake of ART in self-reported HIV positives (79.2%; 76.3%–81.8%) almost reached universal coverage, which is defined at 85% in Zimbabwe, but only about every second lab-confirmed HIV positive person in the study population was on treatment (52.2%; 49.2%–55.1%). MC uptake in the male population remained low (8.2%; 7.5%–8.9%). Knowledge and uptake of services varied by sex and age and may also differ by other factors.