Integration of EPI and paediatric HIV services for improved ART initiation in Zimbabwe - July 2017



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

Meanwhile, Zimbabwe’s Expanded Programme on Immunisation (EPI) consistently demonstrates high coverage rates of childhood vaccinations, particularly for the first and second doses of the pentavalent vaccine, which are scheduled for 6 weeks of age (pentavalent 1) and 10 weeks (pentavalent 2). Given that most Zimbabwean infants interact with a health facility to receive these vaccines, an opportunity exists to integrate and leverage the EPI service to identify HIV exposure status and swiftly link infants to appropriate HIV services.

The Clinton Health Access Initiative designed an intervention in collaboration with Zimbabwe’s Ministry of Health and Child Care that integrated referral for early infant diagnosis into health facility-based EPI services. Standard EPI visits at 6 and 10 weeks of age were used as entry points for referral to early infant testing and receipt of results. In addition to implementing an entry point referral system, the intervention included support to the HIV testing service and paediatric treatment programme.

This impact evaluation assessed whether integration of early infant diagnosis into health facility-based EPI services improved coverage of HIV testing among HIV-exposed infants, and HIV treatment initiation among HIV-positive children.