Zimbabwe

Integrating HIV testing with EPI: a second chance to protect infants

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HIV testing of exposed infants by 6–8 weeks of age is critical for preventing early morbidity and mortality among those who are HIV positive. When HIV-positive infants remain undiagnosed, they lose the opportunity to access antiretroviral therapy (ART) immediately. Zimbabwe’s paediatric HIV treatment guidelines recommend testing HIV-exposed infants at or before 6 weeks of age, yet practical implementation of these guidelines varies. Many demand and supply gaps in service delivery lead to infants either not receiving the HIV test at all or receiving it well beyond the recommended 6 weeks of age.

Main findings

  • No significant difference was observed between the intervention arm and the control arm in HIV testing by 16 weeks, receipt of results by 20 weeks or treatment initiation by 20 weeks.

  • Most caregivers appeared to be satisfied with the care they received.
    Key issues noted by some caregivers included long wait times and inadequate human resource capacity.

  • Healthcare staff reported two main challenges: staffing shortages that made it difficult for nurses to integrate services and delays in the turnaround of HIV test results.

  • Despite the challenges of integrating EID and EPI services, healthcare workers were overwhelmingly positive towards the integration, provided staffing would be increased.

  • The cost of the programme was high, roughly US$43,000, with few HIV-positive infants identified in either group and no difference between study arms.

  • Future interventions would benefit from: (1) incorporating more intensive training to gain buy-in from health facility staff; (2) focusing on facilities with adequate staffing; (3) solving the laboratory challenges that result in delays; and (4) targeting areas with a high prevalence of HIV-positive infants.