Using National Mass Immunisation Campaigns as

an Opportunity to Identify HIV exposed Infants and Channel

them into Follow up Care

Elizabeth ChirapaZimbabwe AIDS Prevention Project-University of ZimbabweDepartment Of Community MedicineP.O. Box A1679 Avondale92 Prince Edward, Milton Park, Harare.Tel: +263-4 707 289 Fax: +263-4 707 291

Author slideElizabeth Chirapa (ZAPP-UZ)Winfreda Chandisarewa (ZAPP-UZ) Lovemore Mupfukura (ZAPP-UZ)Auxilia Muchedzi (ZAPP-UZ)Lynda Stranix-Chibanda (ZAPP-UZ; UZ-

UCSF)Avinash Shetty (Wake Forest University)Community Mobilizers (ZAPP-UZ)Jo Keatinge (EGPAF)

Background Zimbabwe AIDS Prevention Project-

University of Zimbabwe (ZAPP-UZ) is a collaborative service provider and research project between:Stanford University Department of Medicine Wake Forest University Health Sciences University of Zimbabwe Department of

Community Medicine

Background continuedZAPP-UZ supports the

provision of integrated quality ANC and PMTCT services since 2002Five health facilities in

Chitungwiza Financial and technical

support from Elizabeth Glaser Pediatric AIDS Foundation

Chitungwiza is an urban settlement south of Harare

Population- 1.5 million

National Mass Immunisation Campaigns (NMICs)ZAPP-UZ supports national mass

immunisation campaigns (NMICs) in Chitungwiza

Days set aside at national level twice a year to increase immunization coverage

Statement of the ProblemDespite having HIV-specific follow-up

clinics for HIV-exposed infants Only about 35% of eligible infants were

enrolled into care in 2006 (Stranix-Chibanda,2006)Of those enrolled 16% were still in care at 18

months (Stranix-Chibanda,2006)A short-term intervention was therefore

conducted in June 2009 to improve HIV exposed infant follow-up in Chitungwiza

Objectives of Intervention To identify HIV-exposed infants lost to

follow-up using the national immunization campaigns

To channel HIV-exposed infants back into the continuum of care

Description of Intervention In June 2009, the national immunization

campaign was conducted in Chitungwiza Duration of 12 daysFive health centres and 15 outreach points in

the communityTargeting 48 519 children aged below 5 years

Community mobilization was done by the ZAPP-UZ drama group

Description of Interventions HIV-exposed infants were

identified through:Inspection of the Child

Health CardDetermination of the

mother’s HIV status through history taking

Information was collected for HIV-exposed infants on:vaccination statusHIV testing Cotrimoxazole initiation

Description of InterventionGuardians/parents

of HIV exposed infants lost to follow up were:Given information

on HIV prevention, care and treatment services

Issued with referral letters for registration and follow-up care at local clinics

ResultsA total of 585 HIV-exposed infants less

than two years old were identifiedMedian age 9.0 months (Q1=5.0; Q3=15)

Female 315 (54%)Male 264 (45%)Missing 6 ( 1%)

Initiation and resupply of CTX for the 585 HIV-exposed Infants Identified during the NMIC

Never missed CTX resupply

Missed at least 1 resupply of CTX

Never initiated on CTX0%

10%

20%

30%

40%

50%

60%

50%

34%

16%

Percentage of the 585 HIV-exposed infants who had been tested for HIV by age group

<18months > or =18months All ages

47%

39%46%

Age group of the HIV exposed infants

Prop

orti

on o

f H

IV

expo

sed

infa

nts

Initiation on CTX and HIV testing of Infants in the FHS clinic six months before and after the June 2009 National Mass Immunisation Campaign (NMIC) in Chitungwiza

Infants initiated on CTX

Infants tested for HIV0

50

100

150

200

250

300

350

171

95

315

188

Before NMIC After NMIC

Num

ber

of I

nfan

ts

Lessons learntNMICs are a good

opportunity to identify HIV-exposed infants lost to follow up with minimal additional resources required

The Zimbabwe Child Health Card is a useful tool for the identification of HIV exposed infants during NMICs

ChallengesZAPP-UZ Community mobilizes were

overwhelmed by the number of clients requiring HIV information

Unavailability of counseling space at outreach points resulted in:Referral of clients to clinics for counselingPossible loss to follow up of some referred

casesSome of the child health cards were not filled

in completely making identification of HIV-exposed infants difficult

RecommendationsConsider national mass immunization

campaigns as an opportunity to actively identify HIV-exposed infants and channel them into HIV care

Provide HIV care services to HIV-exposed infants at immunization outreach points

There is need to ensure that health workers fill out the child health card accurately and completely

AcknowledgementsChitungwiza communityZimbabwe AIDS Prevention Project-University

of ZimbabweChitungwiza Health Department ZimbabweMinistry of Health and Child Welfare

Zimbabwe.United States Agency for International

DevelopmentThe Department for International DevelopmentElizabeth Glaser Pediatric AIDS FoundationWake Forest University, North Carolina, USA

Thank You

Every child deserves a lifetime...