Enhancing awareness and uptake of home-based care services during the coronavirus disease 2019 pandemic in Zambia.

Background: The COVID-19 pandemic placed pressure on health systems, exposing workforce shortages and prompting innovative strategies to manage patients with mild to moderate symptoms. Home-based care emerged as a practical approach to reduce facility burden while maintaining quality care. Aim: To assess the implementation and acceptability of the COVID-19 home management model in Zambia. Setting: The study was conducted in 11 purposively selected districts with high levels of home-based management. Methods: A comparative cross-sectional study was conducted. Data were collected in June 2023 and September 2023 from 566 individuals with confirmed COVID-19 eligible for home management, sampled systematically from health facility line lists. Descriptive statistics summarised participant characteristics, and multivariable logistic regression identified factors associated with accepting home-based care. Results: Sixty per cent participants were female, with a median age of 28 years. Awareness of the home management model (adjusted odds ratio [AOR] = 5.11; 95% confidence interval [CI]: 2.61-10.0), income between 600 and 1000 kwacha (AOR = 2.64; 95% CI: 1.10-6.85), and perceiving the model as effective (AOR = 7.88; 95% CI: 3.56-18.3) increased odds of acceptance, while formal employment reduced it (AOR = 0.38; 95% CI: 0.18-0.78). Conclusion: Home-based care is a strategy for easing health system pressure. Strengthening awareness and addressing socio-economic barriers could increase uptake in Zambia. Contribution: This study contributes new evidence on the determinants of home-based care uptake within a low-resource context. The study provides actionable insights for policymakers and programme implementers seeking to strengthen community-based models of care.