Reinforcing early infant diagnosis of HIV (3DE)
Client: Zambia Ministry of Health, Zambia Ministry of Community Development, Mother and Child Health
IDinsight service: Randomized evaluation
Health facility staff organizing Children’s Clinic Cards at an Under-5 Clinic Day in Southern Province, Zambia.
Approximately 50% of untreated HIV-infected infants die before the age of 2 years. Recognizing this, Zambia has implemented early infant HIV diagnosis (EID) services in over 800 health facilities nationwide. However, only ~25% of the ~180,000 EID tests per year stipulated by national guidelines are conducted. Thus, improving EID testing rates represents a critical step in improving Zambia’s fight against the HIV epidemic.
Senior officials from Zambia’s MoH and Ministry of Community Development, Mother and Child Health (MoCDMCH) have commissioned an impact evaluation to assess two interventions designed to improve EID testing rates:
1. The “Simple Intervention” targets two potential causes of low EID rates: supply stock outs and poor understanding of testing requirements and guidelines. Health facilities receiving the Simple Intervention will benefit from 1) a guaranteed supply of antibody and dried blood spot (DBS) DNA PCR testing materials and 2) a short workshop from district MoCDMCH staff to review and emphasize existing MoH EID guidelines.
2. The “Comprehensive Intervention” includes the supply and information components of the Simple Intervention, and also introduces 1) an intentional operational optimization and integration of EID testing into routine six-week immunization visits, and 2) an additional component of opt-out rapid HIV testing for all mothers with previously negative or unknown HIV status in order to identify previously unrecognized HIV-exposed infants.
IDinsight designed and is implementing a clustered randomized controlled trial to identify the impact of the Simple and Comprehensive Interventions on the number of HIV exposed infants identified, number of HIV exposed infants tested for HIV, and percentage of infants immunized.