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. 2025 May 27;20(5):e0323919.
doi: 10.1371/journal.pone.0323919. eCollection 2025.

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

Daniel Woytowich  1 , Anne F McIntyre  1 , Hiwote Solomon  1 , Brave Hanunka  2 , Lazarus Chelu  3 , Tepa Nkumbula  3 , Leigh Tally  2 , Ray Handema  4 , Shepherd Khondowe  4 , Kelvin Kapungu  4 , Lophina Chilukutu  3 , Innocent Bwalya  4 , Chipili Mulemfwe  3 , Melvin Mwansa  3 , Kennedy Mutale  5 , Neena M Philip  6 , Giles Reid  6 , Joyce J Neal  7 , Maria Lahuerta  6 , Lauren E Parmley  6 , Hannah Chung  6 , Avi J Hakim  1 , Jonas Z Hines  2 , Evelyn Kim  1 , John Mwale  8 , Lloyd B Mulenga  8   9
Affiliations

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

Daniel Woytowich et al. PLoS One. .

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Progress towards UNAIDS 95-95-95 targets among PWID living with HIV in Livingstone, Lusaka, and Ndola, Zambia, 2021.
Population estimates and 95% Confidence Intervals are weighted using Gile’s SS estimator. ART status is viral load adjusted (<200 copies/mL). VLS is defined as <1000 copies/mL. Conditional percentages are shown.
See this image and copyright information in PMC

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