Background and Objective: More than half of the Zambian population living in urban areas use basic onsite sanitation facilities, most of which are deplorable, with only one-eighth of households relying on safely managed sanitation facilities. We explored the determinants of sewer connection uptake among customers in two communities where the local commercial water utility made the service available. Methods: Between February and December 2021, we conducted surveys with landlords (n=150) in two peri-urban communities to understand their knowledge of sewer connection services, the multi-level determinants, and willingness to connect to a sewer line in the context of COVID-19. Interviews with landlords (n=18) supplemented the quantitative data by how convenience, cost, affiliation, and trust affected their choice to upgrade to a sewer connection. Results: Of 81% of respondents that reported knowing about the available sewer connection service, 76% reported not knowing how much it costs, and 61% reported having insufficient knowledge. The individual, social and structural drivers for having a sewer connection were 1) the perceived health benefits, convenience and affordability in installation and maintenance service costs; 2) the perceived social status and belief that sewer connections work for others in their community and 3) the provision of sufficient information and reassurance of consistent water supply and maintenance services in cases of blockages from the water utility respectively. 27% of respondents said they would no longer connect to a sewer line as their income had reduced due to COVID-19. Of the four personas presented in the interviews, the perceived high service cost and distrust in the utility were the most common reasons that hindered landlords from connecting to the sewer line. Conclusions: Insufficient knowledge of sewer connection services, the lack of trust in the water utility, community support and COVID-19 affected the willingness of landlords to connect to a sewer line.