Initiation of highly active antiretroviral therapy among pregnant women in Cape Town,South Africa

Objective To investigate highly active antiretroviral therapy (HAART) initiation among pregnant women and the optimum model of service delivery for integrating HAART services into antenatal care. Methods We analysed clinic records to reconstruct a cohort of all HIV‐infected pregnant women eligible for HAART at four antenatal clinics representing three service delivery models in Cape Town, South Africa. To assess HAART coverage, records of women determined to be eligible for HAART in pregnancy were reviewed at corresponding HIV treatment services. Results Of 13 208 pregnant women tested for HIV, 26% were HIV‐infected and 15% were HAART‐eligible based on a CD4 cell count of ≤ 200 cells/μl. Among eligible women, 51% initiated HAART before delivery, 27% received another prevention of mother‐to‐child transmission (PMTCT) intervention and 22% did not receive any antiretroviral intervention before delivery. The proportions of women initiating HAART between the different service delivery models were comparable. The median gestational age at first presentation was 26 weeks, and early gestational age at first presentation was the strongest predictor of being on HAART by delivery. Of the women who did not initiate HAART in pregnancy, 24% started treatment within 2 years postpartum. Conclusions In this setting with clear PMTCT and HAART protocols, services failed to prioritize and initiate a high proportion of eligible pregnant women on HAART. The initiation of HAART in pregnancy requires strengthened antenatal and HIV services that target women with advanced stage disease.     

Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities

Objective To present evidence on unit and total costs of outpatient HIV/AIDS services in ZPCT‐supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV/AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother‐to‐child transmission (PMTCT) in Zambia. Methods Cost data from 2008 were collected in 12 ZPCT‐supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV/AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009. Results Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First‐year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT‐supported facilities were estimated at US$14.7–$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0–114.2 million for ART and US$57.7 million for ANC including PMTCT. Conclusions Consistent with the literature, total costs of services were dominated by drugs, laboratory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility‐level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening.     

Universal voluntary HIV testing in antenatal care settings: a review of the contribution of provider-initiated testing & counselling

Objective To assess the contribution of provider‐initiated testing and counselling (PITC) to achieving universal testing of pregnant women and, from available data on components of PITC, assess whether PITC adoption adheres to pre‐test information, post‐test counselling procedures and linkage to treatment. Methods Systematic review of published literature. Findings were collated and data extracted on HIV testing uptake before and after the adoption of a PITC model. Data on pre‐ and post‐test counselling uptake and linkage to anti‐retrovirals, where available, were also extracted. Results Ten eligible studies were identified. Pre‐intervention testing uptake ranged from 5.5% to 78.7%. Following PITC introduction, testing uptake increased by a range of 9.9% to 65.6%, with testing uptake ≥85% in eight studies. Where reported, pre‐test information was provided to between 91.5% and 100% and post‐test counselling to between 82% and 99.8% of pregnant women. Linkage to ARVs for prevention of mother to child transmission (PMTCT) was reported in five studies and ranged from 53.7% to 77.2%. Where reported, PITC was considered acceptable by ANC attendees. Conclusion Our review provides evidence that the adoption of PITC within ANC can facilitate progress towards universal voluntary testing of pregnant women. This is necessary to increase the coverage of PMTCT services and facilitate access to treatment and prevention interventions. We found some evidence that PITC adoption does not undermine processes inherent to good conduct of testing, with high levels of pre‐test information and post‐test counselling, and two studies suggesting that PITC is acceptable to ANC attendees.     

Ensuring HIV‐infected pregnant women start antiretroviral treatment: an operational cohort study from Lilongwe,Malawi

Objectives HIV‐infected women identified through antenatal care (ANC) often fail to access antiretroviral treatment (ART), leaving them and their infants at risk for declining health or HIV transmission. We describe results of measures to improve uptake of ART among eligible pregnant women. Methods Between October 2006 and December 2009, interventions implemented at ANC and ART facilities in urban Lilongwe aimed to better link services for women with CD4 counts <250/μl. A monitoring system followed women referred for ART to examine trends and improve practices in referral completion, on‐time ART initiation and ART retention. Results Six hundred and twelve women were ART eligible: 604 (99%) received their CD4 result, 344 (56%) reached the clinic, 286 (47%) started ART while pregnant and 261 (43%) were either alive on ART or transferred out after 6 months. Between 2006 and 2009, the median (IQR) time between CD4 blood draw and ART initiation fell from 41 days (17, 349) to 15 days (7,42) (P = 0.183); the proportion of eligible individuals starting ART while pregnant and retained for 6 months improved from 17% to 65% (P < 0.001). Delays generally shortened within the continuum of care from 2006 to 2009; however, time from CD4 blood draw to ART referral increased from 7 to 14 days. Conclusions Referrals between facilities and delays through CD4 count measurements create bottlenecks in patient care. Retention improved over time, but delays within the linkage process remained. ART initiation at ANC plus use of point‐of‐care CD4 tests may further enhance ART uptake.     

Use of nutritional and water hygiene packages for diarrhoeal prevention among HIV‐exposed infants in Lilongwe,Malawi: an evaluation of a pilot prevention of mother‐to‐child transmission post‐natal care service

Objective To evaluate a pilot prevention of mother‐to‐child transmission post‐natal programme in Lilongwe, Malawi, through observed retention and infant diarrhoeal rates. Methods Free fortified porridge and water hygiene packages were offered to mothers to encourage frequent post‐natal visits and to reduce diarrhoeal rates in infants on replacement feeding. Participant retention and infant health outcome were assessed. Results Of 474 patients enrolled, 357 (75.3%) completed 3‐month follow‐up visits. Ninety‐nine percent of women reported hygiene package use, and only 17.7% (95% CI 13.8–22.0%) of the infants had diarrhoea at least once over the 3‐month period. Being 12 months or younger, confirmed HIV positive, access to tap water, and having a mother with diarrhoea were all associated with increased risk of infant diarrhoea. Conclusion The majority of participants adhered to their scheduled visits and retention was favourable, possibly because of the introduction of hygiene and nutrition incentives. The infant diarrhoeal rate was low, suggesting benefits of regular medical care with hygiene package usage and reliable replacement feeding options. Continuation and expansion of the programme would allow further studies and improve the post‐natal care of HIV‐exposed infants in Malawi and in other resource‐constrained countries.     

A Safe Motherhood project in Kenya: assessment of antenatal attendance,service provision and implications for PMTCT

Objectives To investigate uptake and provision of antenatal care (ANC) services in the Uzazi Bora project: a demonstration‐intervention project for Safe Motherhood and prevention of mother‐to‐child transmission of HIV in Kenya. Methods Data were extracted from antenatal clinic, laboratory and maternity ward registers of all pregnant women attending ANC from January 2004 until September 2006 at three antenatal clinics in Mombasa and two in rural Kwale district of Coast Province, Kenya (n = 25 364). Multiple logistic and proportional odds logistic regression analyses assessed changes over time, and determinants of the frequency and timing of ANC visits, uptake of HIV testing, and provision of iron sulphate, folate and single‐dose nevirapine (sd‐NVP). Results About half of women in rural and urban settings (52.2% and 49.2%, respectively) attended antenatal clinics only once. Lower parity, urban setting, older age and having received iron sulphate and folate supplements during the first ANC visit were independent predictors of more frequent visits. The first ANC visit occurred after 28 weeks of pregnancy for 30% (5894/19 432) of women. By mid‐2006, provision of nevirapine to HIV‐positive women had increased from 32.5% and 11.7% in rural and urban clinics, to 67.0% and 74.6%, respectively. Equally marked improvements were observed in the uptake of HIV testing and the provision of iron sulphate and folate. Conclusion Provision of ANC services, including sd‐NVP, increased markedly over time. While further improvements in quality are necessary, particular attention is needed to implement evidence‐based interventions to alter ANC utilization patterns. Encouragingly, improved provision of basic essential obstetric care may increase attendance.     

Factors Associated with Low Early Uptake of a National Program to Prevent Mother to Child Transmission of HIV (PMTCT): Results of a Survey of Mothers and Providers, Botswana, 2003

In Francistown, Botswana, approximately 40% of pregnant women are HIV positive. PMTCT has been available since 1999, antiretroviral (ARV) therapy since 2001, and 95% of women have antenatal care (ANC) and deliver in hospital. However, in 2002, only 33% of ANC clients were tested for HIV, and not all women with HIV received services. In 2003, we conducted a survey of 504 pregnant and postpartum women to explore reasons for poor program uptake, and interviewed 82 health providers about PMTCT. Most women (95%) believed that all pregnant women should be tested for HIV. In multivariate analysis, factors associated with having an HIV test included being interviewed at an urban site, having a high PMTCT knowledge score, knowing someone receiving PMTCT or ARV therapy, and having a partner who had been tested for HIV. Neither fear of stigma nor resistance from partners were frequent reasons for refusing an HIV test. Providers of HIV services reported discomfort with their knowledge and skills, and 84% believed HIV testing should be routine. Ensuring adequate knowledge about HIV and PMTCT, creating systems whereby HIV-positive women receiving care can educate and support other women, and making HIV testing routine for pregnant women may improve the uptake of HIV testing.     

Male Involvement in PMTCT Services in Mbeya Region, Tanzania

Throughout all stages of programmes for the prevention of mother-to-child-transmission of HIV (PMTCT), high dropout rates are common. Increased male involvement and couples’ joint HIV counselling/testing during antenatal care (ANC) seem crucial for improving PMTCT outcomes. Our study assessed male attitudes regarding partner involvement into ANC/PMTCT services in Mbeya Region, Tanzania, conducting 124 individual interviews and six focus group discussions. Almost all respondents generally supported PMTCT interventions. Mentioned barriers to ANC/PMTCT attendance included lacking information/knowledge, no time, neglected importance, the services representing a female responsibility, or fear of HIV-test results. Only few perceived couple HIV counselling/testing as disadvantageous. Among fathers who had refused previous ANC/PMTCT attendance, most had done so even though they were not perceiving a disadvantage about couple counselling/testing. The contradiction between men’s beneficial attitudes towards their involvement and low participation rates suggests that external barriers play a large role in this decision-making process and that partner’s needs should be more specifically addressed in ANC/PMTCT services.     

Male Involvement in PMTCT Services in Mbeya Region,Tanzania

Throughout all stages of programmes for the prevention of mother-to-child-transmission of HIV (PMTCT), high dropout rates are common. Increased male involvement and couples’ joint HIV counselling/testing during antenatal care (ANC) seem crucial for improving PMTCT outcomes. Our study assessed male attitudes regarding partner involvement into ANC/PMTCT services in Mbeya Region, Tanzania, conducting 124 individual interviews and six focus group discussions. Almost all respondents generally supported PMTCT interventions. Mentioned barriers to ANC/PMTCT attendance included lacking information/knowledge, no time, neglected importance, the services representing a female responsibility, or fear of HIV-test results. Only few perceived couple HIV counselling/testing as disadvantageous. Among fathers who had refused previous ANC/PMTCT attendance, most had done so even though they were not perceiving a disadvantage about couple counselling/testing. The contradiction between men’s beneficial attitudes towards their involvement and low participation rates suggests that external barriers play a large role in this decision-making process and that partner’s needs should be more specifically addressed in ANC/PMTCT services.     

预防艾滋病母婴传播项目长效工作机制研究

目的通过对深圳市预防艾滋病母婴传播项目工作,与卫生系统多部门常规工作相整合的运行机制进行系统的研究,为其他地区提供有益的借鉴。方法采用定性研究和定量研究。通过文献检索和现有资料收集的方法,了解2008-2010年深圳市孕产妇艾滋病病毒(HIV)抗体检测情况和感染HIV孕妇抗病毒治疗情况。通过小组访谈方法,了解项目运行机制。结果深圳市预防艾滋病母婴传播项目的覆盖率为100%,孕产妇检测率超过95%,孕妇和分娩儿童抗病毒治疗率超过90%。HIV感染孕产妇的产前保健和助产服务整合入妇幼保健常规工作,母婴随访整合入疾控系统HIV感染者随访工作,孕期抗病毒治疗整合入医政系统抗病毒治疗工作。结论与卫生系统多部门的常规工作相整合的工作机制,能够明显提高项目的运行质量,有助于建立高标准的长效运作机制。     

Effect of exposure to clinic-based health education interventions on behavioural intention to prevent mother-to-child transmission of HIV infection

HIV and AIDS incidence among infants in South Africa is on the increase. The uptake of prevention of mother-to-child transmission (PMTCT) interventions is often said to be dependent on the beliefs and educational needs of those requiring PMTCT services. This study therefore sought to examine the effect of clinic-based health education interventions (HEI) on behavioural intention of PMTCT among 300 pregnant women from 4 primary health care clinics in Tshilidzini Hospital catchments area, South Africa. An interview schedule was used to obtain information regarding participants' demographic characteristics, level of exposure to clinic-based HEI, salient beliefs and behavioural intention on PMTCT. The major findings included that approximately 85% of the participants had heard of PMTCT. There was very little association between frequency of antenatal clinic (ANC) visits and level of exposure to PMTCT information. Condom use had the lowest set of salient belief scores. Control belief was the most common belief contributing to behavioural intention. Generally, the association between PMTCT salient beliefs and behavioural intention was weak. Clinic-based HEI had an impact on behavioural intention of HIV testing, normative belief of regular ANC visit and nevirapine use. The vital contribution of alternative PMTCT information sources such as the radio and television was observed. Enhancing initiatives that empower women, and a better coordination of the existing HEI through better implementation of health education strategy may strengthen the prevailing moderate PMTCT intention in the area investigated.     

Depression,retention in care,and uptake of PMTCT service in Kinshasa,the Democratic Republic of Congo: a prospective cohort

There is a clear need for effective strategies to address the factors that affect retention, or lost-to-follow-up (LTFU) and adherence to HIV care and treatment. Depression in particular may play an important role in the high rates of LTFU along the prevention of mother-to-child HIV transmission (PMTCT) cascade in sub-Saharan Africa. This study assessed the association between prenatal depression and (1) LTFU or (2) uptake of PMTCT services. As part of a randomized control trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services, newly diagnosed HIV-infected women, ≤32 weeks pregnant, registering for antenatal care (ANC), in 85 clinics in Kinshasa, Democratic Republic of Congo (DRC), were recruited and followed-up until LTFU, death, transfer out, or six weeks postpartum. Participants were interviewed at enrollment using a questionnaire which included the Patient Health Questionnaire (PHQ-9). Depression was defined as a PHQ-9 score of ≥15. Among 433 women enrolled, 51 (11.8%) had a PHQ-9 score ≥15 including 15 (3.5%) with a score ≥20. At six weeks postpartum, 67 (15.5%) were LFTU and 331 (76.4%) were in care and had accepted all available PTMCT services. Of participants with depression at enrollment, 17.7% (9/51) were LTFU at six weeks postpartum compared to 15.2% (58/382) among those without, but the association was not statistically significant. On the other hand, 78.4% (40/51) of participants with prenatal depression were in care at six weeks postpartum and had attended all their scheduled visits and accepted available services compared to 76.2% (291/382) among those without depression. In this cohort of newly diagnosed HIV-infected pregnant women, prenatal depression assessed with a PHQ-9 score ≥15 was not a strong predictor of LTFU among newly diagnosed HIV-infected women in Kinshasa, DRC.     

Quality of antenatal and delivery care before and after the implementation of a prevention of mother-to-child HIV transmission programme in Côte d'Ivoire

Objective  To assess whether implementation of a prevention of mother-to-child HIV transmission (PMTCT) programme in Côte d'Ivoire improved the quality of antenatal and delivery care services.
Methods  Quality of antenatal and delivery care services was assessed in five urban health facilities before (2002–2003) and after (2005) the implementation of a PMTCT programme through review of facility data; observation of antenatal consultations ( n  = 606 before; n  = 591 after) and deliveries ( n  = 229 before; n  = 231 after) and exit interviews of women; and interviews of health facility staff.
Results  HIV testing was never proposed at baseline and was proposed to 63% of women at the first ANC visit after PMTCT implementation. The overall testing rate was 42% and 83% of tested HIV-infected pregnant women received nevirapine. In addition, inter-personal communication and confidentiality significantly improved in all health facilities. In the maternity ward, quality of obstetrical care at admission, delivery and post-partum care globally improved in all facilities after the implementation of the programme although some indicators remained poor, such as filling in the partograph directly during labour. Episiotomy rates among primiparous women dropped from 64% to 25% ( P  < 0.001) after PMTCT implementation. Global scores for quality of antenatal and delivery care significantly improved in all facilities after the implementation of the programme.
Conclusions  Introducing comprehensive PMTCT services can improve the quality of antenatal and delivery care in general.     

Linking women who test HIV‐positive in pregnancy‐related services to long‐term HIV care and treatment services: a systematic review

Objectives To quantify attrition between women testing HIV‐positive in pregnancy‐related services and accessing long‐term HIV care and treatment services in low‐ or middle‐income countries and to explore the reasons underlying client drop‐out by synthesising current literature on this topic. Methods A systematic search in Medline, EMBASE, Global Health and the International Bibliography of the Social Sciences of literature published 2000–2010. Only studies meeting pre‐defined quality criteria were included. Results Of 2543 articles retrieved, 20 met the inclusion criteria. Sixteen (80%) drew on data from sub‐Saharan Africa. The pathway between testing HIV‐positive in pregnancy‐related services and accessing long‐term HIV‐related services is complex, and attrition was usually high. There was a failure to initiate highly active antiretroviral therapy (HAART) among 38–88% of known‐eligible women. Providing ‘family‐focused care’, and integrating CD4 testing and HAART provision into prevention of mother‐to‐child HIV transmission services appear promising for increasing women’s uptake of HIV‐related services. Individual‐level factors that need to be addressed include financial constraints and fear of stigma. Conclusions Too few women negotiate the many steps between testing HIV‐positive in pregnancy‐related services and accessing HIV‐related services for themselves. Recent efforts to stem patient drop‐out, such as the MTCT‐Plus Initiative, hold promise. Addressing barriers and enabling factors both within health facilities and at the levels of the individual woman, her family and society will be essential to improve the uptake of services.     

Operational evaluation of a service for prevention of mother‐to‐child transmission of HIV in rural Uganda: barriers to uptake of single‐dose nevirapine and the role of birth reporting

Objectives To determine factors associated with pregnant women being HIV positive, barriers to the uptake of single‐dose nevirapine (sdNVP) for prevention of mother‐to‐child transmission (PMTCT) and feasibility and effectiveness of reporting HIV‐exposed infants born in facilities with no PMTCT services so as to receive NVP. Methods From 2002 to 2007, a sdNVP PMTCT service was implemented in 53 rural villages of south‐west Uganda. Twenty‐five of them were HIV‐surveillance study villages. The proportions of mothers testing positive and mother and newborns receiving and ingesting sdNVP and associated factors were determined. Results Women with incomplete primary or no education, aged 25–34 years or not living with their partners were at increased risk of being HIV infected. Seventy‐seven percentage of pregnant women with HIV (PWH) received therapy. Of the 63 PWH who received therapy and had surviving live births, only 39 (62%) reported births and received newborn prophylaxis within 72 h. Women were more likely to collect and ingest NVP if they were from study villages, preferred home administration of newborn NVP or presented at a more advanced stage of pregnancy. Newborns were more likely to be reported and receive NVP if mothers were aged 25–34 years, on antiretroviral therapy (ART) or came from study villages. Conclusions The uptake of PMTCT services was unacceptably low. Asking PWH with less advanced pregnancies to return to collect NVP leads to missed opportunities especially if PWH are less educated. Birth reporting enabled the programme to provide NVP to some infants who otherwise would have missed. Antenatal, delivery and PMTCT services should be integrated.     

Use of routine data collected by the prevention of mother-to-child transmission program for HIV surveillance among pregnant women in Rwanda: opportunities and limitations

To compare HIV prevalence measured by antenatal clinics (ANC) sentinel surveillance and by the prevention of mother-to-child transmission (PMTCT) program in Rwanda. We compared HIV prevalence from anonymous testing performed under ANC surveillance, and that measured from voluntary counselling and testing performed under the PMTCT program, in a random sample of the same population of pregnant women attending for their first antenatal visit at 29 ANC surveillance sites with a PMTCT program in 2007 in Rwanda. All of the 13,318 pregnant women recruited in the ANC surveillance accepted to participate in the PMTCT program. HIV prevalence measured by sentinel surveillance was 4.35% whereas that measured for 1873 pregnant women (out of the total sentinel population) by the PMTCT program was 3.49% (p=0.07). For 3% of the PMTCT population, HIV test results were missing from the counselling logbook versus 0.3% in the ANC laboratory logbooks. For 10 pregnant women, HIV test results were divergent between the PMTCT and the ANC laboratory logbooks. After missing data and errors were corrected, HIV prevalence results from PMTCT was 3.27% (significantly different from ANC surveillance: p =0.03). High uptake of PMTCT program among pregnant women was observed in Rwanda in 2007. HIV prevalence measured by the ANC surveillance and PMTCT program were significantly different. Poor performance in HIV testing practices and PMTCT/laboratories data management could explain this difference. Improvement in HIV testing practices and in PMTCT/laboratory data management are needed in order to use PMTCT data for HIV surveillance and to ensure good performance of all the package of care provided by the PMTCT program.     

A primary care level algorithm for identifying HIV-infected adolescents in populations at high risk through mother-to-child transmission

Objective To present an algorithm for primary‐care health workers for identifying HIV‐infected adolescents in populations at high risk through mother‐to‐child transmission. Methods Five hundred and six adolescent (10–18 years) attendees to two primary care clinics in Harare, Zimbabwe, were recruited. A randomly extracted ‘training’ data set (n = 251) was used to generate an algorithm using variables identified as associated with HIV through multivariable logistic regression. Performance characteristics of the algorithm were evaluated in the remaining (‘test’) records (n = 255) at different HIV prevalence rates. Results HIV prevalence was 17%, and infection was independently associated with client‐reported orphanhood, past hospitalization, skin problems, presenting with sexually transmitted infection and poor functional ability. Classifying adolescents as requiring HIV testing if they reported >1 of these five criteria had 74% sensitivity and 80% specificity for HIV, with the algorithm correctly predicting the HIV status of 79% of participants. In low‐HIV‐prevalence settings (<2%), the algorithm would have a high negative predictive value (≥99.5%) and result in an estimated 60% decrease in the number of people needing to test to identify one HIV‐infected individual, compared with universal testing. Conclusions Our simple algorithm can identify which individuals are likely to be HIV infected with sufficient accuracy to provide a screening tool for use in settings not already implementing universal testing policies among this age‐group, for example immigrants to low‐HIV‐prevalence countries.     

Training community care workers to provide comprehensive TB/HIV/PMTCT integrated care in KwaZulu‐Natal: lessons learnt

Objective To describe a participatory approach to implement and evaluate ways to integrate and train community care workers (CCWs) to enhance collaborative TB/HIV/PMTCT activities, and home‐based HIV counseling and testing (HCT) at community level. Methods The intervention study was conducted in Sisonke, a rural district of KwaZulu Natal, South Africa. A baseline household (HH) survey was conducted in 11 villages. Six villages were randomly selected into intervention and control clusters. Training was provided first to CCWs from the intervention cluster (IC) followed by the control cluster (CC). Routine monthly data from CCWs were collected from March–December 2010. The data was subjected to bivariate tests. Results The baseline HH survey revealed that of 3012 HH members visited by CCWs in 2008, 21% were screened for TB symptoms, 7% were visited for TB adherence support and 2% for ART adherence, and 1.5% were counselled on infant feeding options. A total of 89 CCWs were trained. Data show that during the study period in IC, 684 adults were offered HCT by CCWs, 92% accepted HCT and tested and 7% tested HIV‐positive and were referred to the clinic for further care. Of 3556 adults served in IC, 44% were screened for TB symptoms and 32% for symptoms of sexually transmitted infections (STIs) and 37% of children were traced as TB contact. Out of 6226 adults served in CC, 10% were screened for TB symptoms and 7% for STI symptoms. The differences in uptake of services between IC and CC were statistically significant (p < 0.05). Conclusion The findings of this study suggest higher uptake of TB and STI symptoms screening, TB contact tracing and home based HCT in the intervention clusters. This study suggests that up‐skilling CCWs could be one avenue to enhance TB/HIV case finding, TB contact tracing and linkages to care.