Leveraging HIV Program and Civil Society to Accelerate COVID-19 Vaccine Uptake, Zambia

To accelerate COVID-19 vaccination delivery, Zambia integrated COVID-19 vaccination into HIV treatment centers and used World AIDS Day 2021 to launch a national vaccination campaign. This campaign was associated with significantly increased vaccinations, demonstrating that HIV programs can be leveraged to increase COVID-19 vaccine uptake.

bers in the country. Successful strategies for engaging HIV treatment centers included using existing human resources by adequately preparing HIV healthcare workers to offer vaccination and encouraging them to get vaccinated themselves, developing targeted promotional materials for persons living with HIV who are at increased risk for severe illness (3), and rapidly adapting and implementing similar models across the country. After this preparatory work, Zambia used the annual World AIDS Day event to launch its December Campaign to help reach African Union targets (4), focusing on engaging civil society leaders to endorse vaccination and using a mixed service delivery model that added community-delivered vaccination based on successful community HIV programs to existing static service delivery (Table). Some strategies were adapted from Zambia's robust childhood vaccination program (5).
To evaluate whether the December Campaign accelerated COVID-19 vaccination in Zambia, we conducted time-series analyses by using publicly available data (Appendix, https://wwwnc.cdc.gov/EID/ article/28/13/22-0743-App1.pdf) (1). All participants entered in the Our World in Data (https://ourworldindata.org/ dataset by February 21, 2022, for Zambia and 55 African Union member states were eligible for the analysis. We conducted 3 statistical analyses. First, in a single-group interrupted time-series analysis in Zambia only, we compared the number of persons reaching full vaccination status per day before the December 1, 2021, campaign start versus after the campaign start. Second, in a multigroup interrupted time-series analysis, we assessed whether Zambia's acceleration in COVID-19 vaccination coverage (i.e., acceleration in the percentage of total population reaching full vaccination status per day) after the December Campaign intervention was statistically superior to 2 control groups: 2 neighboring countries with similar pre-intervention vaccination coverage trajectories and similar vaccine availability, and the average for all 55 Africa Union member states. Third, we implemented   Table 3).
Compared with the average for 2 neighboring countries with similar vaccination trends before December and vaccine availability, Zambia acceler-ated its population COVID-19 vaccine coverage rate by an additional 2.73%/month (p<0.001) (Figure, panel B; Appendix Table 4). Compared with Africa as a whole, Zambia vaccine coverage accelerated by 1.87%/month (p<0.001) (Figure, panel C; Appendix Table 5). This accelerated vaccination in Zambia was robust to the sensitivity analysis for which we used an interpolation approach to missing data instead of the approach carrying forward the most recent available data point (Appendix Tables 3, 6). In addition, the average post-December daily vaccination rate dropped only slightly, and the average post-December percentage gain per day in a fully vaccinated population remained relatively stable, indicating a sustained effect for nearly 3 months after the December Campaign launch. If current trends were sustained,  • Leverage existing in-country systems/programs/resources for COVID-19 vaccination.
• Engage national, provincial, and district health bodies from the outset.
• Develop district-level microplans based on standard tools that are approved at provincial and national levels. • Use joint planning by Ministry of Health, funding organizations, and provincial representatives.
• Establish centralized M&E tools for national tracking of progress.
• Begin with a small pilot in a few sites and rapidly iterate to improve quality, using a continuous quality-improvement approach. • Scale-up successful practices rapidly to quickly enhance effect.
• Develop targets that can be implemented and achieved by lower levels (i.e., district health offices, service delivery teams). Service delivery • Adequately capacitate HCWs in HIV, MCH, and other clinics to deliver COVID-19 vaccines.
• Invest in community mobilization and service delivery to overcome limits of a static service delivery approach and reach the greatest number of eligible persons, which means offering vaccines at public places (e.g., markets, malls, churches), chiefdoms, workplaces, congregate settings, and others. • Use existing community health services for HIV as vaccination points.
• Anticipate additional human resource needs, and ensure adequate financial resources to support them. Zambia could reach its targeted 70% eligible population coverage in November 2023, ahead of other countries in Africa (August 2024) (Appendix Table 7). For Africa to reach the 2022 Africa Union targets and adequately protect the continent from subsequent COVID-19 waves, substantially accelerated COVID-19 vaccination delivery is needed (4). Moreover, rapidly reaching high vaccination coverage in Africa can help reduce the risk for emergence of new variants that can rapidly spread globally (6,7). These data suggest that strong government leadership can leverage a robust HIV program, civil society, and integrated HIV donor support from the US President's Emergency Plan for AIDS Relief and others to rapidly increase COVID-19 vaccine uptake. Zambia`s example could hasten similar adaptations in other Africa countries.