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

Introduction Good nutrition in People Living with HIV (PLHIV) has a good influence on treatment outcomes and in turn a better quality of life. Despite, the significant role it plays, many patients have limited access to Nutritional Assessment Counselling and Support (NACS). We evaluated undernutrition in people living with HIV and associated factors in Muchinga Province, Zambia, from October 2019 to March 2020. Material and Methods This was secondary analysis of routine program data of HIV-positive clients on ART enrolled at EQUIP-supported health facilities in Muchinga. 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). Multivariate-adjusted odds ratios (aOR) were used to assess factors associated with undernutrition. Results Of 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 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 TLD (aOR= 2.8; 95%CI: 1.23 – 6.23) were more likely to be under-nourished. Conclusion NACS played a vital role in identifying HIV-positive clients who required more specialized care for improved clinical health outcomes. There is a need to strengthen HIV and nutrition integration in low-resourced countries with high HIV burden for improved treatment outcomes and quality of life. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Initials of authors: EM, IS, BC, CC, ES, TM and PM Grant no:AID-OAA-A-15-00070 Name of funder: The United States Agency for International Development The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Permission to access de-identified client data was granted by Right to Care Zambia Not for Profit Organisation (NPO). Ethics was obtained from ERES CONVERGE IRB, Zambia (IRB No. 00005948). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files