Knowledge level on treatment-as-prevention among HIV sero-positive adults on antiretroviral therapy in three health facilities of Lusaka district in Zambia.

Abstract

Background: Knowledge on treatment-as-prevention is envisioned as a motivation intervention for optimal adherence to antiretroviral therapy (ART) and attainment of viral load (VL) suppression. Thereby averting sexual transmission of new HIV infections. Hence, the study assessed knowledge on treatment-as-prevention among people living with HIV (PLHIV) on ART, and the factors associated with knowledge on TasP in Lusaka district of Zambia. Methods: A cross sectional study design was used concurrently with in-depth interviews (IDIs) between December 2018 and January 2019. Kalingalinga, Chipata, and Chilenje public health facilities were selected for data collection due to short turnaround time of VL test results. The 63.4% prevalence of suppressed VL in Lusaka Province was used to calculate the sample size of 362 respondents by applying the single proportion formula. The sample was apportioned to the study sites using probability proportional to size. The simple random technique was used to select respondents aged 18-59 years-old and on ART for over nine months. Stata version 14 was used to analyse quantitative data. Reported frequencies, proportions, confidence intervals (CIs), and p-values using chi square tests. In the multivariate binary logistic regression, unadjusted odds ratio and adjusted odds ratio (aOR) with CIs and p-values were reported. Followed up 55 participants for IDIs drawn from 362 respondents. The selection was varied based on VL levels. Microsoft office word was used to write up hand written interviews, informal observation notes, and to transcribe audio-recorded interviews. Notes and transcripts were combined and analysed thematically. Convergent and divergent quantitative and qualitative findings were merged in the discussion. Results: Of the 362 PLHIV on ART : (a) 125 (34.5%, 95% CI: 9.14 to 42.9, p < 0.01) reported having knowledge on treatment-as-prevention, (b) there was less than 50% difference in knowledge across the statistically significant social – demographic variables with p < 0.5, (c) 102 (28.2%) knew had suppressed VL, 10 (2.8%) knew had unsuppressed VL and 250 (69.0%) did not know their VL test rests, and (d) those with unsuppressed VLs were (aOR=2.65, 95% CI: 1.29 to 5.42, p < 0.01) associated with knowledge on TasP compared to those with suppressed VLs. While the facilitators for knowledge on treatment-as-prevention were: (1) ssources of knowledge including friends on ART, learning by being in a discordant relationship, self-taught through internet, radio, health care providers, and through enhanced adherence counseling especially among those with unsuppressed VL, and (2) benefits of ‘treatment-as-prevention’ consisting of reduced stigma and worry-free sexual relationship due to negligible risk to infect partner. The barriers comprised: (1) inadequate literacy on VL and its implication on HIV transmission but with more emphasis on CD4 count literacy, (2) waiting time affected follow up of VL results and to attend literacy sessions, (3) extended fast track short-visits limited interaction with literacy sessions, and (4) undetectable VL is perceived transmittable. Conclusion: The findings imply that by increasing knowledge level on TasP among PLHIV on ART and addressing barriers of waiting time and extended fast track short-visits could motivate optimal adherence to ART and avert VL rebounds. Key Terms: Treatment-as-prevention, Knowledge level, Viral Load, Antiretroviral, HIV Positive, Sexual transmission, Lusaka, and Adults