title: A Cluster Randomised Trial on the Impact of Integrating Early Infant HIV Diagnosis with the Expanded Programme on Immunization on Immunization and HIV Testing Rates in Rural Health Facilities in Southern Zambia.
abstract: BACKGROUND
  We assessed the integration of early infant HIV diagnosis with the expanded programme for immunization in a rural Zambian setting with the aim of determining whether infant and postpartum maternal HIV testing rates would increase without harming immunization uptake.
  
  
  METHODS
  In an unblinded, location stratified, cluster randomised controlled trial, 60 facilities in Zambia's Southern Province were equally allocated to a control group, Simple Intervention group that received a sensitization meeting and the resupply of HIV testing commodities in the event of a stock-out, and a Comprehensive Intervention group that received the Simple Intervention as well as on-site operational support to facilitate the integration of HIV testing services with EPI.
  
  
  RESULTS
  The average change in number of first dose diphtheria, pertussis, and tetanus vaccine (DPT1) provided per month, per facility was approximately 0.86 doses higher [90% confidence interval (CI) -1.40, 3.12] in Comprehensive Intervention facilities compared to the combined average change in the Simple Intervention and control facilities. The interventions resulted in a 16.6% [90% CI: -7%, 46%, P-value = 0.26] and 10% [90% CI: -10%, 36%, P-value = 0.43] greater change in average monthly infant DBS testing compared to control for the Simple and Comprehensive facilities respectively. We also found 15.76 (90% CI: 7.12, 24.41, P-value < 0.01) and 10.93 (90% CI: 1.52, 20.33, P-value = 0.06) additional total maternal re-tests over baseline for the Simple and Comprehensive Facilities respectively.
  
  
  CONCLUSIONS
  This study provides strong evidence to support Zambia's policy of integration of HIV testing and EPI services. Actions in line with the interventions, including HIV testing material supply reinforcement, can increase HIV testing rates without harming immunization uptake. In response, Zambia's Ministry of Health issued a memo to remind health facilities to provide HIV testing at under-five clinics and to include under-five HIV testing as part of district performance assessments.
  
  
  BACKGROUND
  ClinicalTrials.gov
  
  
  BACKGROUND
  NCT02479659.
authors.affiliation: IDinsight Zambia, IDinsight, Lusaka, Zambia.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Wang
authors.affiliation: Directorate of Disease Surveillance and Research, Ministry of Health, Lusaka, Zambia.
authors.forename: Albert
authors.initials: A
authors.lastname: Mwango
authors.affiliation: Applied Analytics Team, Clinton Health Access Initiative, Melbourne, Victoria, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Moberley
authors.affiliation: IDinsight Zambia, IDinsight, Lusaka, Zambia.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Brockman
authors.affiliation: IDinsight Zambia, IDinsight, Lusaka, Zambia.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Connor
authors.affiliation: Child Health, Zambian Ministry of Community Development, Maternal and Child Health, Lusaka, Zambia.
authors.forename: Penelope
authors.initials: P
authors.lastname: Kalesha-Masumbu
authors.affiliation: Directorate of Disease Surveillance and Research, Ministry of Health, Lusaka, Zambia.
authors.forename: Simon
authors.initials: S
authors.lastname: Mutembo
authors.affiliation: Directorate of Disease Surveillance and Research, Ministry of Health, Lusaka, Zambia.
authors.forename: Maximillian
authors.initials: M
authors.lastname: Bweupe
authors.affiliation: Directorate of Disease Surveillance and Research, Ministry of Health, Lusaka, Zambia.
authors.forename: Pascalina
authors.initials: P
authors.lastname: Chanda-Kapata
authors.affiliation: Country Office, Zambian Centre for Applied Health Research and Development, Lusaka, Zambia; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Biemba
authors.affiliation: Country Office, Zambian Centre for Applied Health Research and Development, Lusaka, Zambia; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, United States of America; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.affiliation: Country Office, Clinton Health Access Initiative, Lusaka, Zambia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chibuye
authors.affiliation: Applied Analytics Team, Clinton Health Access Initiative, Lusaka, Zambia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McCarthy
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000379:methods*; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000627:therapeutic use*; D042241:Early Diagnosis; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000453:epidemiology; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D012424:Rural Population; D014611:Vaccination / Q000379:methods* / Q000706:statistics & numerical data; D015024:Zambia
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine