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Evaluation of Using Routine Infant Immunization Visits to Identify and Follow-Up HIV-Exposed Infants and Their Mothers in Tanzania

Goodson, James L. MPH*; Finkbeiner, Thomas MD; Davis, Nicole L. MPH; Lyimo, Dafrossa MD§; Rwebembera, Anath MD; Swartzendruber, Andrea L. MPH, PhD; Wallace, Aaron S. MPH*; Kimambo, Sajida MPH, MD; Kimario, Chrispin J. MD; Wiktor, Stefan Z. MD; Luman, Elizabeth T. PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2013 - Volume 63 - Issue 1 - p e9–e15
doi: 10.1097/QAI.0b013e31828a3e3f
Implementation and Operational Research: Epidemiology and Prevention

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.

Findings: 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.

Interpretation: 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.

*Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA;

Division of Global HIV/AIDS Program, Centers for Diseases Control and Prevention, Dar es Salaam, Tanzania;

Division of Global HIV/AIDS Program, Centers for Diseases Control and Prevention, Atlanta, GA;

§Expanded Program on Immunization, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania;

National AIDS Control Program, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania; and

Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania.

Correspondence to: James L. Goodson, Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS-E05, Atlanta, GA 30333 (e-mail: jgoodson@cdc.gov).

The US Centers for Disease Control and Prevention provided funding and participated in study design, data analysis, report writing, and decisions to submit the article for publication.

The authors J.L.G., T.F., N.D., L.D., N.R., A.S., A.W., S.K., C.K., S.W., and E.T.L. designed the study. J.L.G., T.F., N.D., L.D., N.R., A.W., S.K., C.K., and E.T.L. participated in data collection. J.L.G., T.F., A.W., S.K., J.V.E., R.E.D., and E.T.L. participated in data analysis and interpretation. J.L.G., T.F., S.K., A.W., and E.T.L. wrote the report. All authors reviewed and approved the final report.

The authors have no conflicts of interest to disclose.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.

The authors do not have a financial or proprietary interest in a product, method, or material or lack thereof.

Received July 28, 2012

Accepted October 28, 2012

© 2013 Lippincott Williams & Wilkins, Inc.