Extreme weather disrupts HIV and TB care in Zimbabwe

Health systems already stretched in low-resource settings face growing threats from extreme weather events. In Zimbabwe, the 2023/2024 El Niño-induced drought worsened food insecurity and made it harder for vulnerable people to reach clinics and get their medications. To understand how these climate shocks affect people with HIV and tuberculosis (TB), Canice Christian led a formative evaluation that directly asked affected communities and frontline health workers about their experiences. The study combined a large survey of people living with HIV (PLHIV) and discussions with people affected by HIV and TB to document what is actually happening on the ground and to identify climate-adaptive health-service strategies. Researchers surveyed 1,804 PLHIV across 321 clinics and held six focus group discussions with HIV- and TB-affected individuals. The goal was to move beyond conceptual ideas about climate and health and to gather empirical, patient-reported evidence about how drought, heat, floods, and other extreme weather events are changing people’s ability to stay on treatment and maintain care.

The study used two complementary methods: a large multi-district patient survey and qualitative focus group discussions. Of the 1,804 surveyed PLHIV, 76% (1,363/1,804) said they had noticed changes in the climate over the past five years, and 75% (1,024/1,364) reported that those changes had disrupted their HIV care. Among those who reported disruptions, 86% (877/1,024) pointed to increased food insecurity and 65% (667/1,024) to water shortages as dominant barriers to sticking with treatment. The focus groups (n=6) reinforced the survey findings, describing widespread food shortages, crop failures, and livestock deaths that reduced household income and made it harder to afford food and transport to clinics. Participants and frontline health workers highlighted mental health stress and mobility barriers as additional challenges. They also prioritized practical solutions such as nutrition and water support, transportation assistance, income-generating activities, and decentralized models of healthcare delivery to keep people on treatment during climate shocks.

These findings underline a clear message: as climate change makes extreme weather more common, health programs for HIV and TB must adapt. The study suggests that social protections—such as food and water assistance, transport support, and livelihood programs—can reduce the hidden costs patients face during droughts and floods. Decentralizing services so care can be delivered closer to people’s homes, and integrating climate-adaptive approaches into existing HIV and TB programs, could protect continuity of care and reduce treatment interruptions. By documenting patient-reported impacts and community-prioritized solutions, the research points to concrete, practical steps health systems can take now to build resilience and protect vulnerable populations in Zimbabwe and similar high-burden, climate-vulnerable settings.