Objectives: Social protections can mitigate poverty's effects on HIV, but program implementation may influence their impact. We explored relationships between multidimensional poverty, social protections programming, and HIV viral load (VL) among a population living with and seeking care for HIV (PLHIV) in Zimbabwe.

Design: A Sequential Explanatory Mixed Methods Study.

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

Results: Among 13722 PLHIV (65.4% female, median age 44 years [Interquartile range: 36-52]), 44.4% were multidimensionally poor. Only 18% had ever received social protections. Poverty was associated with VL non-suppression [adjusted prevalence ratio (aPR) = 1.55; (95% confidence interval (CI): 1.13, 2.13], as was social protections receipt [aPR = 1.67; (95% CI: 1.07, 2.62)]. IDIs showed that PLHIV experienced significant impoverishment, had little information about and access to social protections, and reported limited quantities and durations of receipt.

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

Keywords: HIV; Zimbabwe; health behavior; poverty; socioeconomic factors; viral load.

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目标： 社会保护措施可以缓解贫困对艾滋病的影响，但项目实施可能会影响其效果。我们探讨了多维度贫困、社会保护计划与生活在津巴布韦并寻求艾滋病护理的人群（PLHIV）的病毒载量（VL）之间的关系。

设计： 本研究采用顺序解释混合方法研究设计。

方法： 我们分析了2023年1月至7月期间在津巴布韦15个地区收集的成人艾滋病患者满意度调查的回顾性横断面数据。我们使用描述性分析、广义估计方程和调节分析来评估多维度贫困、社会保护措施与病毒载量非抑制之间的关系。2023年8月至9月期间，我们对成年人进行了半结构化深入访谈（IDIs），讨论结核病护理和社会保护干预的获取情况。我们应用了探索、准备、实施和维持框架进行质性分析，并在解释阶段整合了结果。

结果： 在13722名PLHIV中（65.4%为女性，中位年龄为44岁[四分位范围：36-52]），44.4%的人处于多维度贫困状态。只有18%的人曾接受过社会保护措施。贫困与病毒载量非抑制有关 [调整后的优势比 (aPR) = 1.55；95% 置信区间 (CI): 1.13, 2.13]，同样，获得社会保护措施也与此相关 [aPR = 1.67; (95% CI: 1.07, 2.62)]。IDIs 显示 PLHIV 经历了严重的贫困化，对社会保护措施的信息和获取了解很少，并报告了收到的数量和时间有限。

结论： 我们观察到高负担的贫困以及脆弱的社会保障获取情况。多维度贫困与病毒学非抑制有关，同样，获得社会保护措施也可能表明我们人口中的显著脆弱性和社会保障覆盖不足及响应能力低下。

关键词： 艾滋病；津巴布韦；健康行为；贫困；经济社会因素；病毒载量。

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