Additional file 1: of Antiretroviral therapy improves survival among TB-HIV co-infected patients who have CD4+ T-cell count above 350cells/mm3

Survival times used to perform the survival analysis. (CSV 3 kb)

Proportion of inpatient children eligible for PITC that were counselled and tested.

<p>Line graph demonstrates the proportion of inpatient children eligible for PITC that (a) were counselled, and (b) were tested for HIV, by each quarter in the 36-month period following the introduction of PITC. Counselling and testing rates climb to over 99%.</p

Percentage of total HIV tests that were positive, by age group.

<p>Bar graph demonstrates, by quarter in a 36-month period (a) what proportion of total inpatient and outpatient children tested were identified HIV-infected, (b) what proportion of these children were under and over 18 months old.</p

Table_1_HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study.DOCX

BackgroundGlobally, most countries have implemented a test-and-treat policy to reduce morbidity and mortality associated with HIV infection. However, the impact of this strategy has not been critically appraised in many settings, including Zambia. We evaluated the retention and clinical outcomes of adults enrolled in antiretroviral therapy (ART) and assessed the impact of the test-and-treat policy.MethodsWe conducted a retrospective cohort study among 6,640 individuals who initiated ART between January 1, 2014 and July 31, 2016 [before test-and-treat cohort (BTT), n = 2,991] and between August 1, 2016 and October 1, 2020 [after test-and-treat cohort (ATT), n = 3,649] in 12 districts of the Southern province. To assess factors associated with retention, we used logistic regression (xtlogit model).ResultsThe median age [interquartile range (IQR)] was 34.8 years (28.0, 42.1), and 60.2% (n = 3,995) were women. The overall retention was 83.4% [95% confidence interval (CI) 82.6, 84.4], and it was significantly higher among the ATT cohort, 90.6 vs. 74.8%, p ConclusionThe retention rate and attrition factors improved in the ATT compared to the BTT cohorts. Drivers of retention were test-and-treat policy, older age, high BMI, rural residence, marital status, and WHO stage 1. Therefore, there is need for interventions targeting young people, urban residents, non-married people, and those in the symptomatic WHO stages and with low BMI. Our findings highlight improved ART retention after the implementation of the test-and-treat policy.</p

Multivariate Linear Regression Results for the Montly Average Number of DPT1 Doses Comparing Comprehensive Group to Combined Control & Simple Groups.

<p>Multivariate Linear Regression Results for the Montly Average Number of DPT1 Doses Comparing Comprehensive Group to Combined Control & Simple Groups.</p

The average number of infant DBS testing during baseline and intervention periods per facility, by intervention.

<p>The blue bars represent the average number of infant DBS tests per facility in each study arm at baseline. The red bars represent the corresponding average number of infant DBS tests during the six month intervention period.</p

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

<div><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Findings</p><p>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.</p><p>Conclusions</p><p>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.</p><p>Trial Registration</p><p>ClinicalTrials.gov Registration Number: <a href="https://clinicaltrials.gov/ct2/show/study/NCT02479659?term=early+infant+diagnosis+and+HIV+and+Zambia&rank=1" target="_blank">NCT02479659</a></p></div

Linear Regression Results of Intervention Arm on Logged Outcome (Number of DBS Tests per Facility per Month).

<p>Linear Regression Results of Intervention Arm on Logged Outcome (Number of DBS Tests per Facility per Month).</p

Table_2_HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study.DOC

BackgroundGlobally, most countries have implemented a test-and-treat policy to reduce morbidity and mortality associated with HIV infection. However, the impact of this strategy has not been critically appraised in many settings, including Zambia. We evaluated the retention and clinical outcomes of adults enrolled in antiretroviral therapy (ART) and assessed the impact of the test-and-treat policy.MethodsWe conducted a retrospective cohort study among 6,640 individuals who initiated ART between January 1, 2014 and July 31, 2016 [before test-and-treat cohort (BTT), n = 2,991] and between August 1, 2016 and October 1, 2020 [after test-and-treat cohort (ATT), n = 3,649] in 12 districts of the Southern province. To assess factors associated with retention, we used logistic regression (xtlogit model).ResultsThe median age [interquartile range (IQR)] was 34.8 years (28.0, 42.1), and 60.2% (n = 3,995) were women. The overall retention was 83.4% [95% confidence interval (CI) 82.6, 84.4], and it was significantly higher among the ATT cohort, 90.6 vs. 74.8%, p ConclusionThe retention rate and attrition factors improved in the ATT compared to the BTT cohorts. Drivers of retention were test-and-treat policy, older age, high BMI, rural residence, marital status, and WHO stage 1. Therefore, there is need for interventions targeting young people, urban residents, non-married people, and those in the symptomatic WHO stages and with low BMI. Our findings highlight improved ART retention after the implementation of the test-and-treat policy.</p

Summary and baseline characteristics by intervention arm.

<p>* The intervention arms were regressed as indicator variables on each outcome. After the regression, an F-test was used to test for equality between the three evaluation arms. At the time of sampling, all samples with p-values of less than 0.90 for DBS, DPT, and ANC averages were removed from consideration. Since that time, more complete data are available, explaining the 0.89 p-value for the DBS tests at the final sample.</p><p>Summary and baseline characteristics by intervention arm.</p