Results and best practices from Kids to Care pilot projects

Project Overview and Objectives
The COWLHA-led pilot project in Malawi focused on targeted HIV testing for underserved children, particularly those born to female sex workers (FSWs) and through traditional birth attendants (TBAs). The initiative responded to gaps in mass testing approaches that failed to identify many children living with HIV (CLHIV). The project aimed to enhance HIV testing, linkage to care, and treatment adherence for children aged 0–14 and their mothers, with a strong emphasis on community-based outreach and psychosocial support. It also sought to eliminate vertical transmission and improve maternal health outcomes.

Key Outcomes and Lessons Learned
The project tested 121 underserved children, identifying 9 newly HIV-positive children (7.4% positivity rate), while an additional 2 previously known HIV-positive children who were not yet on treatment were initiated on ART, bringing the total newly enrolled on ART to 11. Through peer-led outreach, 14 children who had defaulted were successfully traced and returned to care, confirming that the program addressed both newly identified cases and lost to follow up children. Although child-level data were not fully disaggregated by pathway, both FSW peer educators and TBAs significantly contributed to identifying underserved children: FSWs reached hidden peers and their children through safe-space hotspots in villages, while TBAs traced children born outside the health system using informal delivery records. This peer-driven approach also supported defaulter tracing for both mothers and children, explaining the strong viral suppression outcome of 71.4% (10 of 14 children retained in care). Among pregnant and breastfeeding women, TBAs referred 268 women for health-facility delivery, 16 of whom tested positive at the facility and were immediately started on ART, ensuring HIV-free deliveries (32 recorded). These results collectively demonstrate that targeted testing through FSW and TBA networks enabled the program to reach children and mothers who would otherwise remain untested or LTFU, thereby improving testing uptake, ART initiation, retention, and overall treatment outcomes.

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Project Overview and Objectives

Zoe-Life’s YouThrive Together pilot in KwaZulu-Natal, South Africa, extended the KidzAlive model to adolescents (10–14 years), young mothers (under 24), and children of sex workers, groups often underserved in traditional HIV programmes. Zoe-Life partnered with Lubanzi Ulwazi Resource Centre and Mothers for the Future, both community-based organizations (CBOs), to deliver services across clinics, homes, and community settingThe project aimed to bridge service gaps in identification, testing, and ongoing support for children and adolescents living with HIV. To do this, the team employed innovative case-finding approaches such as risk-screening cards (“My People My Places”), school sensitization sessions, and outreach through sex worker networks. Services included HIV testing and linkage to care, disclosure support, adherence counselling, psychosocial support, and education on sexual and reproductive health, mental health, and child development

Key Outcomes and Lessons

Learned Despite the short implementation timeline, the pilot also collaborated with district health facilities and government departments, which engaged actively and expressed willingness to integrate project components, indicating strong relevance and potential sustainability. The YouThrive pilot demonstrated strong progress in identifying and supporting children and adolescents living with HIV, with most programme targets achieved or exceeded. Intensive outreach activities resulted in 129 adolescents being screened and 60 tested for HIV, while 51 young mothers were screened and 21 of their children tested. Implemented over 11 months, the programme trained 12 participants (including five Champions). Among children of sex workers, an especially hard-to-reach population, 48 children were tested, with three newly identified as HIV positive and enrolled in care. The programme’s disclosure support processes further strengthened identification and linkage pathways, helping adolescents understand their HIV status and improve adherence, with several showing reduced viral loads. Champions played a pivotal role by creating safe, trusted spaces that encouraged families to participate in testing and follow-up support, particularly in clinics, schools, and community locations. The pilot underscored that identifying children and adolescents living with HIV requires adequate time, trained facilitators skilled in working with younger children, and intentionally designed outreach strategies. Many children lived far from their caregivers’ workplaces or in areas not routinely served by health programmes, making flexible approaches crucial to identifying children living with HIV. Strong partnerships with CBOs expanded outreach to highly mobile and hidden populations. Zoe-Life’s work reinforces that peer-led and community-driven models, combined with targeted risk-screening tools, are essential for reaching the most underserved children and linking them to sustained, child-friendly care.

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Project Overview and Objectives
The Copper Rose Zambia (CRZ) Kids to Care pilot aimed to improve HIV testing, treatment adherence, and care for underserved children in Lusaka Province by strengthening school-linked pathways and community–facility collaboration. The pilot centred on enabling children to remain in school while accessing regular follow-up through school-based and home-based support systems.

Key Outcomes and Lessons Learned

The pilot promoted the use of school structures for HIV testing, psychosocial support, and health services. The project tested 3,581 children for HIV, identifying 23 HIV-positive children, all of whom were linked to ART initiation and counselling. Key strategies included school open days, school health clubs, school-based safe spaces, home visits, home-based drug refills by Community Health Workers (CHWs), reminder systems, and close collaboration among teachers, caregivers, and CHWs. The pilot was highly adaptive, continuously adjusting approaches based on learning and what worked best for increasing identification, retention, and follow-up. Schools played an increasingly central role as partners in identification, referral, and psychosocial support, with teachers, caregivers, and CHWs working together to identify at-risk children, provide follow-up support, and trace children who had missed appointments. Although not all facilities adopted the new scheduling approaches, several did so successfully, demonstrating feasibility and acceptability. The pilot also navigated operational challenges such as HIV test-kit shortages, which were resolved through district-level redistribution and joint problem-solving sessions with key stakeholders. The experience highlighted the importance of early and sustained stakeholder engagement, particularly with education-sector leaders whose buy-in proved essential. CopperRose’s model emphasizes that integrating schools more closely with health facilities and community systems can transform adherence outcomes for children. It also points to the need for continued advocacy to embed flexible clinic scheduling and multi-month dispensing for children within national HIV treatment guidelines.

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