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Case Studies | September 11, 2017

Summary of Key Approaches on Improving HIV Testing and Services for Children Orphaned or Made Vulnerable by HIV (OVC)

Expanded IMPACT Program in Zimbabwe Lea Toto and APHIAplus Nuru ya Bonde programs in Kenya Yekokeb Berhan Program for Highly Vulnerable Children in Ethiopia

This report summarizes the strengths, challenges, lessons learned and remaining gaps of the Lea Toto and APHIAplus programs in Kenya, the Yekokeb Berhan Project in Ethiopia and the EIP in Zimbabwe. Specifically, this report documents each program’s efforts to (a) test 100% of HIV-exposed infants, children and adolescents, and promptly treat those with vertically acquired infection, and (b) identify all children ages newborn to 17 years with acquired HIV infection, and link them promptly to care and treatment.

  • Acknowledgements
  • Acronyms
  • Purpose of the HIV Testing and Services (HTS) Case Studies
    • Selection of the Case Studies
    • Methodology
  • HIV Testing and Services within OVC Programming
  • Barriers to HTS for children
  • Strengths and successes
    • PLHIV engagement is crucial to overcoming barriers
    • Large, multi-sectoral OVC programs can tackle HIV barriers without stigmatizing individual children
    • Health and social services, working together, address barriers more effectively
    • A “one team” approach delivers streamlined, holistic care
    • Supporting government leadership and building on existing structures lends credibility and promotes sustainability
    • Other important initiatives
  • Gaps and challenges
    • Lack of guidance to support optimal disclosure to children
    • Lack of evidence on effective approaches to support to children and adolescents with HIV
    • Lack of evidence on effective approaches to support caregivers of children living with HIV
    • Stigma is still a major barrier
    • Underserved and hard-to-reach households: Is there a role for specially trained community volunteers in the provision of home testing?
  • Considerations for OVC programming
    • Reduce stigma and build compassion for children with HIV
    • Develop evidence-based approaches to address HIV disclosure, positive living and treatment adherence among children and adolescents
    • Consider the needs of children who may have horizontally acquired HIV
    • Improve data management to enable effective case management
  • Conclusion
  • Annex: Literature Review on Barriers to HIV Testing and Effective Linkage to Care for Children