title: Evaluation of using routine infant immunization visits to identify and follow-up HIV-exposed infants and their mothers in Tanzania.
abstract: BACKGROUND
  Without treatment, approximately half of HIV-infected infants die by age 2 years, and 80% die before age 5 years. Early identification of HIV-infected and HIV-exposed infants provides opportunities for life-saving interventions. We evaluated integration of HIV-related services with routine infant immunization in Tanzania.
  
  
  METHODS
  During April 2009 to March 2010, at 4 urban and 4 rural sites, mothers' HIV status was determined at first-month immunization using antenatal cards. HIV-exposed infants were offered HIV testing and follow-up care. Impact of integrated service delivery was assessed by comparing average monthly vaccine doses administered during the study period and a 2-year baseline period; acceptance was assessed by interviewing mothers and service providers.
  
  
  RESULTS
  During 7569 visits, 308 HIV-exposed infants were identified and registered; of these, 290 (94%) were tested, 15 (5%) were HIV infected. At urban sites, first-month vaccine doses remained stable (+2% for pentavalent vaccine and -4% for polio vaccine), and vaccine doses given later in life (pentavalent, polio, and measles) increased 12%, 8%, and 11%, respectively. At rural sites, first-month vaccine doses decreased 33% and 35% and vaccine doses given later in life decreased 23%, 28%, and 28%. Mothers and service providers generally favored integrated services; however, HIV-related stigma and inadequate confidentiality controls of HIV testing were identified, particularly at rural sites.
  
  
  CONCLUSIONS
  Integration of HIV-related services at immunization visits identified HIV-exposed infants, HIV-infected infants, and HIV-infected mothers; however, decreases in vaccine doses administered at rural sites were concerning. HIV-related service integration with immunization visits needs careful monitoring to ensure optimum vaccine delivery.
authors: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. jgoodson@cdc.gov
authors: James L
authors: JL
authors: Goodson
authors: Thomas
authors: T
authors: Finkbeiner
authors: Nicole L
authors: NL
authors: Davis
authors: Dafrossa
authors: D
authors: Lyimo
authors: Anath
authors: A
authors: Rwebembera
authors: Andrea L
authors: AL
authors: Swartzendruber
authors: Aaron S
authors: AS
authors: Wallace
authors: Sajida
authors: S
authors: Kimambo
authors: Chrispin J
authors: CJ
authors: Kimario
authors: Stefan Z
authors: SZ
authors: Wiktor
authors: Elizabeth T
authors: ET
authors: Luman
mesh_terms: D000328:Adult; D003695:Delivery of Health Care; D019033:Delivery of Health Care, Integrated; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007115:Immunization Schedule; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D007407:Interviews as Topic; D008297:Male; D009035:Mothers; D012424:Rural Population / Q000706:statistics & numerical data; D013636:Tanzania; D014505:Urban Population / Q000706:statistics & numerical data; D014612:Vaccines / Q000008:administration & dosage
chemical_list: D014612:Vaccines