South Africa has the largest antiretroviral programme worldwide, including children. Yet the health system is failing to keep children on treatment, to do routine viral load monitoring, and provide timeous interventions to ensure viral suppression is achieved. As a result, many of the children living with HIV are unsuppressed, altering HIV from a manageable chronic disease to one that is fatal. 

To address the gap in the health system, Zoë-Life launched a targeted intervention, called KidzAdherence Clubs, as part of their evidence-based model of care, KidzAlive. 

KidzAdherence Clubs provide children living with HIV age-appropriate medication literacy and psychosocial support. Various play therapy techniques are used such as story-telling, art and games to increase children’s understanding of HIV and wellness journey. The intervention is implemented through the capacity-building of healthcare workers to deliver a structured, activity-based curriculum, aimed at children and their primary caregivers.

Children and caregivers are separated into appropriate groups, whereby caregivers receive their own content aimed at supporting adherence for their children, whilst children receive their own fun-based sessions to help them learn important information regarding taking age-appropriate responsibility for the management of their health.

KidzAdherence Clubs are focused on the provision of HIV psychosocial and adherence support in a group environment, at both community and facility levels and caters for stable (most recent viral loads undetectable) and unstable (newly initiated on ART or most recent viral load detectable) children on ART. 

Stable children join “Nginamandla” (I am Strong!) clubs whilst unstable children attend the ”Ngisekele” (Help me!) clubs. The power of peer-to-peer support is key to building lasting support systems, whereby regular meetings and talking through similar problems groups may face, encouraging sharing of information and strategies to apply solutions. Feelings of isolation, hopelessness and fear are relieved, these feelings are a major contributor to poor adherence. 

Unstable children and their caregivers are provided with advanced adherence support to help them get back on track. The standard is a full adherence assessment to determine barriers to adherence, tailored service provision (such as disclosure support) based on identified barriers, more regular psychosocial adherence counselling for both children and their caregivers, and viral load monitoring on a 3-monthly basis to stabilise those at risk. 

KidzAdherence Club registers, developed by Zoë-Life, are placed at sites that run the intervention, providing evidence and data thus simplifying the tracking and tracing system of children lost to follow up. 

The first club launched in May 2021 and was a great success. Caregiver/children pairs came in large numbers, showing clients are committed and understand the value of this intervention. Children loved the sessions and activities with caregivers reporting a sense of excitement as the date for their next club meeting approached. Zoë-Life scaled this intervention to 4 new facilities in 2 districts and at community level, working in partnership with a community-based organisation called SIZA Community Care. 

Aidsfonds will continue to fund this work by Zoë-Life, whereby the KidzAdherence Clubs will play an essential role - to ensure that no child will be left behind.