Reinforcing Early Infant Diagnosis of HIV (3DE)

Location: Zambia
ClientZambia Ministry of Health, Zambia Ministry of Community Development, Mother and Child Health
Sectors: Health
IDinsight service: Randomized evaluation
PartnersDFIDClinton Health Access Initiative, Zambia Center for Applied Health Research and Development (ZCAHRD)

Background
Approximately 50% of untreated HIV-infected infants die before the age of 2 years.  Recognizing this, Zambia has implemented early infant HIV diagnosis (EID) services in over 800 health facilities nationwide.  However, only ~25% of the ~180,000 EID tests per year stipulated by national guidelines are conducted.  Thus, improving EID testing rates represents a critical step in improving Zambia’s fight against the HIV epidemic.

Interventions
Senior officials from Zambia’s MoH and Ministry of Community Development, Mother and Child Health (MoCDMCH) commissioned an impact evaluation to assess two interventions designed to improve EID testing rates:

 1. The “Simple Intervention” targeted two potential causes of low EID rates: supply stock outs and poor understanding of testing requirements and guidelines. Health facilities receiving the Simple Intervention benefit ed from 1) a guaranteed supply of antibody and dried blood spot (DBS) DNA PCR testing materials and 2) a short workshop from district MoCDMCH staff to review and emphasize existing MoH EID guidelines.

2. The “Comprehensive Intervention” included the supply and information components of the Simple Intervention, and also introduced 1) an intentional operational optimization and integration of EID testing into routine six-week immunization visits, and 2) an additional component of opt-out rapid HIV testing for all mothers with previously negative or unknown HIV status in order to identify previously unrecognized HIV-exposed infants.

IDinsight service
IDinsight designed and implemented a clustered randomized controlled trial to identify the impact of the Simple and Comprehensive Interventions on the number of HIV exposed infants identified, number of HIV exposed infants tested for HIV, and percentage of infants immunized.

Click here to read the EID policy brief.