The Integrated Management of Paediatric AIDS Care and Treatment (IMPACT) Approach in Zimbabwe

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1 The Integrated Management of Paediatric AIDS Care and Treatment (IMPACT) Approach in Zimbabwe Working to Improve ART Access for Zimbabwe s Children Dr. Farai Charasika Director of Programs World Education, Inc./Bantwana

2 Zimbabwe Context Paediatric ART coverage is severely lagging behind adult ART Adult coverage is currently > 85% and paediatric coverage is 51% Currently there are 200,615 HIV infected Zimbabwean children <15 years 111,421 children <14 years are in need of ART 9,674 children die of HIV related causes per year

3 Paediatric ART in Zimbabwe Overall Art Coverage Adult ART Coverage Paediatric ART Coverage

4 Challenges in Paediatric & Adolescent HIV Care in Zimbabwe Loss to follow-up of HIV-exposed infants Poor identification of HIV infected children Families reluctant to seek care near home due to confidentiality issues Cases come in late (i.e. high viral loads, low CD4 count) Access cost of transport to health centers Centralized care slow to scale-up and out to local clinics in rural areas Lack of confidence of clinical staff to prescribe

5 IMPACT Goals and Objectives To identify HIV+ve children and address barriers inhibiting their access to ART services To connect HIV+ve children with ART services including, testing, counseling, CD4 monitoring and treatment adherence To identify, mobilize, and follow up HIV+ve children from ages 2-18 years, through trained community volunteers To offer a safe space for families to share experiences and gain knowledge on how to live positively with HIV IMPACT is a component of Vana Bantwana, a 5-year OVC Care and Support program, funded by USAID/PEPFAR

6 IMPACT Model Stakeholders Community-Based Volunteers (Village Health Workers, Case Care Workers, NGO volunteers): Identify and follow up HIV-exposed infants and children to ensure they have regular access to care, treatment, and support Local Health Facility: Co-ordinates regular meetings between themselves, CBOs and community-based volunteers; conducts community outreach, counseling & testing and initiates HIV+ve children on treatment Local NGO Partners: Provide critical wrap-around services, referrals and information for families with HIV+ve children

7 Platforms of Service Delivery The IMPACT Model

8 IMPACT: Numbers Reached Total IMPACT Reach with HIV Services Children on ART By Age Male Female Total Male Female Total <15 ( age 1-14) , ,164 (85%) >15-18yrs (15%) Total , ,369

9 IMPACT Program Results Marked improvement in the general health of HIV+ children Improved adherence of HIV+ve children on treatment Children are able to access a continuum of wraparound services --health, nutrition, economic strengthening, education, legal services etc. through support from community volunteers Children have better school attendance without illness related interruptions Adolescents in the program are a positive influence on their peers

10 Program Results (Cont) Stigma and discrimination reduced as evidenced by guardians bringing their children for HIV testing Identification of HIV-infected children increased due to support from community leaders Waiting period from diagnosis to commencing ARVs reduced from three months to two weeks Through formation of child support groups, children now have a voice to share their experiences in a non-threatening environment Community forums and parent support groups created to act as safety nets for infected and affected children

11 IMPACT Considerations for Program Scale Up Household and Community Challenges (Demand Side) Stigma and Exclusivity Loss to followup Household food security Financial barriers Low levels of volunteer motivation Contextual Challenges HIV+ve children and family members were stigmatized and shunned. Post PMTCT mother-baby pairs lost due to inadequate follow-up and support. High food insecurity in program areas compromises nutritional status of families and children on ARVs High transport costs reduce frequency of clinic visits and undermines ARV adherence Community volunteers require support for transport and logistic expenses WEI/Bantwana Responses Led campaigns to reduce stigma and to encourage HIV testing and treatment for infected children. Formed mother support groups and case management support for PMTCT mothers and families. Provided community and household nutrition gardens. Invited families to participate in savings and lending (ISAL) groups to increase disposable income. Enrolled volunteers in ISAL groups and provided non-monetary incentives.

12 IMPACT Considerations for Program Scale Up Health Center Challenges (Supply Side) Contextual Challenges WEI/Bantwana Responses Early infant diagnosis Staff confidence Continuum of care Poor coordination Holistic programming Limited access to diagnosis (loss to follow-up, limited test kits, long turnaround time for results). Lack of competence and confidence of health workers to initiate paediatric ART. Poor linkages between testing, PMTCT and treatment programs lead to poor paediatric ART retention. Medical supplies/drugs and reagents are limited and do not reach lower-level facilities. Weak links between paediatric HIV and other critical wraparound services. Support timely transportation of HIV test samples to designated district-level collection points. Roll out training, mentoring, and regular support supervision for district nursing officers and community sisters (Registered Nurses). Establish complete referral cycle from communities to facilities. Build capacity of district health teams to improve supply chain coordination. Expand and strengthen programming beyond ART provision to include treatment literacy, ISAL groups for caregivers, nutrition education, PSS and parenting skills.

13 Thank you! Acknowledgements PEPFAR-USAID Zimbabwe Health Office World Education Inc. and their Partners Ministry of Health and Child Care Department of Social Services Beneficiaries of the Project Dr. Farai Charasika