A Cluster Randomised Trial on the Impact of Integrating Early Infant HIV Diagnosis with the Expanded Programme on Immunization on Immunization and HIV Testing Rates in Rural Health Facilities in Southern Zambia
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 stratif...
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Published in | PloS one Vol. 10; no. 10; p. e0141455 |
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Main Authors | , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Public Library of Science
29.10.2015
Public Library of Science (PLoS) |
Subjects | |
Online Access | Get full text |
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Summary: | 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.
ClinicalTrials.gov
NCT02479659. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23 Conceived and designed the experiments: PW AM EM. Performed the experiments: PW BB. Analyzed the data: PW AM S. Moberley BB AC PK S. Mutembo MB PC GB DH BC EM. Contributed reagents/materials/analysis tools: PW. Wrote the paper: PW AM S. Moberley BB AC PK S. Mutembo MB PC GB DH BC EM. Competing Interests: The authors have declared that no competing interests exist. Current address: National Centre for Immunization Research and Surveillance, Westmead, New South Wales, Australia Current address: Routine Immunisation, World Health Organization, Lusaka, Zambia Current address: John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts, United States of America Current address: Country Office, International Growth Centre, Lusaka, Zambia |
ISSN: | 1932-6203 1932-6203 |
DOI: | 10.1371/journal.pone.0141455 |