Undernutrition and associated factors among people living with HIV under NACS assessment in Muchinga Province, Zambia, 2019-2020

Abstract IntroductionNutrition plays an important role in the management of people living with HIV (PLHIV), yet undernutrition which is one of the world’s most serious health problems remains under researched particularly amongst PLHIV. With more than 1.2 million PLHIV, Zambia is one of the countries most affected by HIV globally. In 2014, Zambia’s undernutrition level was ranked highest in Africa and second from the bottom in the world at 48%. With paucity of literature on undernutrition status among PLHIV in Zambia, we sought to determine undernutrition prevalence and associated factors in PLHIV in Muchinga Province, Zambia.MethodsThis was secondary analysis of routine program data from October 2019 to March 2020 of HIV-positive clients on ART enrolled at supported health facilities in Muchinga with integrated Nutrition Assessment, Counselling and Support (NACS) into the continuum of care. Undernutrition was determined using body mass index (BMI) calculations and classified as undernutrition (< 18.5 kg/m2), normal (18.5 − 24.9 kg/m2) or over-nutrition (overweight, 25–29.9 kg/m2 and obese, 25–29.9 kg/m2). Bivariate and Multivariate-adjusted odds ratios (aOR) were used to assess factors associated with undernutrition.ResultsOf the 506 eligible clients under NACS, the mean age was 34.9 years ± 13.5SD, with 251 (approximately 50%) between the ages of 21–39 years. More than half (67%) were females, 284 (56%) were urban residents, and 180 (35.6%) were unemployed. The majority (approximately 71%) were on the tenofovir disoproxil fumarate/lamivudine/efavirenz (TLE) regimen with a median duration on ART treatment of ~ 3 years (IQR = 1– 6). There were 233 (46%) who had a normal BMI, 191 (37.7%) who had under-nutrition, and 82 (16.2%) who had over-nutrition (9.7% overweight: 6.5% obesity). Clients in the urban area (aOR = 2.0; 95%CI: 1.28–3.1), unemployed (aOR = 2.4 (1.18–4.69)2.4; 95%CI: 1.18–4.69), married (aOR = 2.3; 95%CI: 1.26–4.38) and being on tenofovir/lamivudine/dolutegravir (TLD) (aOR = 2.8; 95%CI: 1.23–6.23) were more likely to be undernourished.ConclusionClients on TLD ART regimen, married, residing in the urban areas and unemployed were found to be positively associated with undernutrition. Therefore, the implementation of nutritional programs such as the NACS was vital in identifying HIV/AIDS patients on ART who required more specialized care for improved nutritional status and clinical health outcomes.