Using National Mass Immunisation Campaigns as an Opportunity to Identify HIV exposed Infants and Channel them into Follow up Care Elizabeth Chirapa Zimbabwe AIDS Prevention Project-University of Zimbabwe Department Of Community Medicine P.O. Box A1679 Avondale 92 Prince Edward, Milton Park, Harare. Tel: Fax:

Author slide Elizabeth 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)

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

Background continued ZAPP-UZ supports the provision of integrated quality ANC and PMTCT services since 2002 Five 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

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

Statement of the Problem Despite 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

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

Description of Intervention In June 2009, the national immunization campaign was conducted in Chitungwiza Duration of 12 days Five health centres and 15 outreach points in the community Targeting children aged below 5 years Community mobilization was done by the ZAPP- UZ drama group

Description of Interventions HIV-exposed infants were identified through: Inspection of the Child Health Card Determination of the mother’s HIV status through history taking Information was collected for HIV-exposed infants on: vaccination status HIV testing Cotrimoxazole initiation

Description of Intervention Guardians/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

Results A total of 585 HIV-exposed infants less than two years old were identified Median age 9.0 months (Q1=5.0; Q3=15) Female 315 (54%) Male 264 (45%) Missing 6 ( 1%)

Initiation and resupply of CTX for the 585 HIV-exposed Infants Identified during the NMIC

Percentage of the 585 HIV-exposed infants who had been tested for HIV by age group

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

Lessons learnt NMICs 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

Challenges ZAPP-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 counseling Possible loss to follow up of some referred cases Some of the child health cards were not filled in completely making identification of HIV-exposed infants difficult

Recommendations Consider 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

Acknowledgements Chitungwiza community Zimbabwe AIDS Prevention Project-University of Zimbabwe Chitungwiza Health Department Zimbabwe Ministry of Health and Child Welfare Zimbabwe. United States Agency for International Development The Department for International Development Elizabeth Glaser Pediatric AIDS Foundation Wake Forest University, North Carolina, USA

Thank You Every child deserves a lifetime...