Prevalence and Risk Factors of HIV Drug Resistance in Zimbabwe: Evidence from Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2020 Survey

(1) Background: HIV drug resistance (HIVDR) poses a significant challenge to the effectiveness of antiretroviral therapy and the overall management of HIVand AIDS. Understanding the predictors of HIVDR is critical for developing strategies to mitigate its impact. The objectives of this study were to identify the predictors of HIVDR among Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA 2020) study participants, a national population-based survey. (2) Methods: Data from people living with HIV who participated in the ZIMPHIA 2020 were used to determine the predictors of HIVDR. (3) Results: The prevalence of HIVDR was 44.9%. Acquired HIVDR was present in 76.1% of people with a virological failure and transmitted resistance is 22.6% in naïve individuals. Factors associated with HIVDR in adjusted analysis were the number of lifetime sexual partners (aOR = 1.03, 95% CI: 1.01-1.06, <i>p</i> = 0.017), each additional year since the first HIV positive result (aOR = 1.17, 95% CI: 1.09-1.25, <i>p</i> < 0.01), each additional year on ART (aOR = 1.14, 95% CI: 1.06-1.23, <i>p</i> = 0.001), initiating ART before 2014 (aOR = 3.08, 95% CI: 1.72-5.49, <i>p</i> = 0.020), ever had switched antiretrovirals (aOR = 2.47, 95% CI: 1.15-5.29, <i>p</i> = 0.020) or had ever had a viral load test (aOR = 2.54, 95% CI: 1.54-4.17, <i>p</i> < 0.001) and a CD4 count < 350 (aOR = 2.04, 95% CI: 1.48-2.83, <i>p</i> < 0.01), while age ≥ 50 (aOR = 0.56, 95% CI: 0.32-0.98, 32 <i>p</i> = 0.04), condom use at last encounter (OR: 0.49, 95%CI: 0.33-0.73, <i>p</i> < 0.001), and not being on ART (aOR = 0.09, 95% CI: 0.06-0.13, <i>p</i> < 0.01) were associated with reduced odds of HIVDR. Conclusions: HIVDR was high among the participants. There is a need to address HIVDR and enhance the mechanisms already in place. This study introduces more information that would help in developing targeted interventions to prevent HIVDR and improve patient outcomes.