# Local data for local programming: Results from an HIV biobehavioral survey among people who inject drugs in Livingstone, Lusaka, and Ndola, Zambia, 2021

## TL;DR

This study reports on HIV prevalence and treatment outcomes among people who inject drugs in three Zambian cities, showing significant gaps in awareness and treatment progress.

## Contribution

The paper provides site-specific data on HIV status and treatment outcomes among PWID in Zambia, highlighting local disparities in meeting UNAIDS targets.

## Key findings

- HIV prevalence among PWID was highest in Ndola (21.9%) and lowest in Lusaka (7.3%).
- Lusaka showed the least progress toward UNAIDS 95-95-95 targets, with low rates of HIV awareness and viral load suppression.
- Livingstone achieved all three UNAIDS targets, with 100% of HIV-positive PWID on ART and achieving viral load suppression.

## Abstract

People who inject drugs (PWID) in Zambia are an understudied population at high risk for HIV acquisition and transmission. We report here on the progress within the PWID communities of Livingstone, Lusaka, and Ndola, Zambia towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets.

A biobehavioral survey used respondent-driven sampling to survey 235 PWID in Livingstone, 349 in Lusaka, and 259 in Ndola in 2021–22. Questions on HIV and injection drug use were administered, and blood was collected for HIV, syphilis, Hepatitis B, and Hepatitis C testing. Weighted prevalence and 95% confidence intervals (CIs) were calculated using Gile’s sequential sampling estimator.

In Livingstone, Lusaka, and Ndola, HIV prevalence among PWID was 11.9% (95% CI: 7.3, 16.5), 7.3% (95% CI: 4.5, 10.2), and 21.9% (95% CI: 14.5, 29.3), respectively. Among HIV-positive PWID in Livingstone, 70.7% (95% CI: 55.4, 85.0) were aware of their HIV status (95% is 1st UNAIDS target), 100% of those were on antiretroviral therapy (ART) (95% is 2nd UNAIDS target), and 100% of those achieved viral load suppression (VLS) (95% is 3rd UNAIDS target). In Lusaka, 66.0% (95% CI: 49.3, 82.2) were aware, 75.7% (95% CI: 51.1, 99.9) were on ART, and 66.3% (95% CI: 42.1, 90.9) achieved VLS. In Ndola, 60.2% (95% CI: 44.1, 76.0), 100%, and 90.2% (95% CI: 82.2, 98.3) were aware, on ART, and achieved VLS, respectively.

Awareness of HIV status was low among PWID living in Livingstone, Lusaka, and Ndola, Zambia. Treatment and VLS progress were lacking in Lusaka and Ndola as well with Lusaka showing the least progress toward all three UNAIDS targets. Our site-level findings highlight critical gaps in PWID-specific HIV awareness, treatment, and VLS status in three major urban areas in Zambia that limit progress toward HIV epidemic control in this hard-to-reach population.