HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study.

Background: Globally, most countries have implemented a test-and-treat policy to reduce morbidity and mortality associated with HIV infection. However, the impact of this strategy has not been critically appraised in many settings, including Zambia. We evaluated the retention and clinical outcomes of adults enrolled in antiretroviral therapy (ART) and assessed the impact of the test-and-treat policy. Methods: We conducted a retrospective cohort study among 6,640 individuals who initiated ART between January 1, 2014 and July 31, 2016 [before test-and-treat cohort (BTT), n = 2,991] and between August 1, 2016 and October 1, 2020 [after test-and-treat cohort (ATT), n = 3,649] in 12 districts of the Southern province. To assess factors associated with retention, we used logistic regression (xtlogit model). Results: The median age [interquartile range (IQR)] was 34.8 years (28.0, 42.1), and 60.2% (n = 3,995) were women. The overall retention was 83.4% [95% confidence interval (CI) 82.6, 84.4], and it was significantly higher among the ATT cohort, 90.6 vs. 74.8%, p < 0.001. The reasons for attrition were higher in the BTT compared to the ATT cohorts: stopped treatment (0.3 vs. 0.1%), transferred out (9.3 vs. 3.2%), lost to follow-up (13.5 vs. 5.9%), and death (1.4 vs. 0.2%). Retention in care was significantly associated with the ATT cohort, increasing age and baseline body mass index (BMI), rural residence, and WHO stage 2, while non-retention was associated with never being married, divorced, and being in WHO stage 3. Conclusion: The retention rate and attrition factors improved in the ATT compared to the BTT cohorts. Drivers of retention were test-and-treat policy, older age, high BMI, rural residence, marital status, and WHO stage 1. Therefore, there is need for interventions targeting young people, urban residents, non-married people, and those in the symptomatic WHO stages and with low BMI. Our findings highlight improved ART retention after the implementation of the test-and-treat policy.

Cross-sectional study of face mask use during the COVID-19 pandemic-Lusaka and Mansa Districts, Zambia, December 2020.

Introduction: coronavirus disease (COVID-19) is primarily spread through respiratory secretions of infected persons, and face mask use has shown to decrease transmission. In Zambia, anecdotal evidence indicates low face mask use among the general population. We objectively assessed face masks use among Lusaka and Mansa residents in December 2020. Methods: we conducted a cross sectional study of face mask usage in Lusaka and Mansa Districts from 16-23 December 2020. A standardized tool was used to visually observe face mask usage and correct face mask usage at various outdoor locations in Lusaka and Mansa. Logistic regression was used to determine association of face mask use and correct face mask use with selected demographic variables. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results: in total, 4070 persons were observed in Lusaka and 1166 Mansa Districts. Face masks usage was 24% in Lusaka and 27% in Mansa. Among the persons wearing face masks, 621 (48%) wore them correctly (52% in Lusaka and 35% in Mansa; p < 0.01 for difference). Being at a health facility (OR: 10.11 [95% CI: 7.99 - 12.81]), shopping mall (OR: 6.38 [95% CI: 5.07 - 8.03]), and school (OR: 2.39 [95% CI: 1.85 - 3.10]) were associated with wearing face masks compared to being at a bus station. Conclusion: face masks usage in public spaces was low in the two districts in Zambia, which might reduce efforts to control COVID-19. Investigating reasons for poor face masks adherence may help formulate effective strategies to increase face masks utilization in Zambia.