We assessed the integration of early infant HIV diagnosis
with the expanded programme for immunization in a rural Zambian setting with
the aim of determining whether infant and postpartum maternal HIV testing rates
would increase without harming immunization uptake.
In an unblinded, location stratified, cluster randomised
controlled trial, 60 facilities in Zambia’s Southern Province were equally
allocated to a control group, Simple Intervention group that received a
sensitization meeting and the resupply of HIV testing commodities in the event
of a stock-out, and a Comprehensive Intervention group that received the Simple
Intervention as well as on-site operational support to facilitate the
integration of HIV testing services with EPI.
The average change in number of first dose diphtheria,
pertussis, and tetanus vaccine (DPT1) provided per month, per facility was
approximately 0.86 doses higher [90% confidence interval (CI) -1.40, 3.12] in
Comprehensive Intervention facilities compared to the combined average change
in the Simple Intervention and control facilities. The interventions resulted
in a 16.6% [90% CI: -7%, 46%, P-value = 0.26] and 10% [90% CI: -10%, 36%,
P-value = 0.43] greater change in average monthly infant DBS testing compared
to control for the Simple and Comprehensive facilities respectively. We also
found 15.76 (90% CI: 7.12, 24.41, P-value < 0.01) and 10.93 (90% CI: 1.52,
20.33, P-value = 0.06) additional total maternal re-tests over baseline for the
Simple and Comprehensive Facilities respectively.
This
study provides strong evidence to support Zambia’s policy of integration of HIV
testing and EPI services. Actions in line with the interventions, including HIV
testing material supply reinforcement, can increase HIV testing rates without
harming immunization uptake. In response, Zambia’s Ministry of Health issued a
memo to remind health facilities to provide HIV testing at under-five clinics
and to include under-five HIV testing as part of district performance assessments.
Below: The average number of infant DBS testing during baseline and intervention periods per facility, by intervention. The blue bars represent the average number of infant DBS tests per facility in each study arm at baseline. The red bars represent the corresponding average number of infant DBS tests during the six month intervention period.
Below: The average number of monthly maternal retests during baseline and intervention per facility, by intervention arm. The bar chart displays the average number of monthly maternal retests both done at the six week under-five visit, as well as the total number of monthly maternal retests during the baseline and the intervention periods across the three intervention arms. The bars in blue represent values at baseline, while bars in red represent values during the six month intervention period.
Full article
at:
By:
Paul C. Wang, Benjamin J. Brockman, Alison L. Connor
IDinsight Zambia, IDinsight,
Lusaka, Zambia
Albert Mwango, Simon Mutembo, Maximillian Bweupe, Pascalina
Chanda-Kapata
Directorate of Disease
Surveillance and Research, Ministry of Health, Lusaka, Zambia
Sarah Moberley
Applied Analytics Team, Clinton
Health Access Initiative, Melbourne, Victoria, Australia
Penelope Kalesha-Masumbu
Child Health, Zambian Ministry
of Community Development, Maternal and Child Health, Lusaka, Zambia
Godfrey Biemba, Davidson H. Hamer
Country Office, Zambian Centre
for Applied Health Research and Development, Lusaka, Zambia
Godfrey Biemba, Davidson H. Hamer
Center for Global Health and
Development, Boston University School of Public Health, Boston, Massachusetts,
United States of America
Davidson H. Hamer
Department of Global Health,
Boston University School of Public Health, Boston, Massachusetts, United States
of America
Benjamin Chibuye
Country Office, Clinton Health
Access Initiative, Lusaka, Zambia
Elizabeth McCarthy
Applied Analytics Team, Clinton
Health Access Initiative, Lusaka, Zambia
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