Download - Zimbabwe AIDS Prevention Project- University of Zimbabwe Department Of Community Medicine
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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
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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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%)
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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%
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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
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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
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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
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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
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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
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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
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Thank You
Every child deserves a lifetime...