Closing the Paediatric HIV Testing and Treatment Gap

South Africa has made significant progress in HIV treatment for adults, but gaps remain for children. Many children living with HIV are still diagnosed late or missed entirely, particularly when they fall outside routine prevention programmes.

Barriers such as weak referral systems, limited knowledge among caregivers about HIV and HIV treatment, stigma, and a lack of coordination between community services and health facilities can prevent children from accessing or remaining in care. As a result, many children are lost to follow-up or start treatment too late.

Without targeted action, these children risk poorer health outcomes and missed opportunities for healthy development.

The project ensures that more children living with HIV are diagnosed earlier, start treatment sooner and remain healthy throughout childhood and adolescence. Working alongside families, communities and health facilities, it helps children move successfully from identification to testing, treatment and long-term care.

To achieve this, the project will:

• Identify children at risk of HIV and refer them to testing
• Help children diagnosed with HIV start treatment as early as possible
• Support children and families to remain in care and achieve viral suppression
• Equip caregivers and adolescents with the knowledge and confidence to manage HIV treatment
• Use real-time data to track children across the care pathway and reduce loss to follow-up
• Strengthen paediatric HIV services by working with healthcare workers, community outreach officers and civil society organisations
• Influence policies that make effective paediatric HIV services sustainable and scalable
• Support the integration of paediatric HIV services into community and public health systems
  

Through community-led approaches, the project actively searches for children who may be living with HIV but remain undiagnosed. Community organisations conduct household screening and outreach through schools, early childhood development centres and churches to identify children at risk of HIV and connect them to testing. Children diagnosed with HIV are supported throughout their journey into treatment and care.

The CARE-AI platform helps community workers identify children at risk, track referrals and follow up children who may otherwise be lost to care. By combining digital tools with personal support, the project strengthens continuity of care and improves the chances that children receive timely treatment and remain engaged in care.

Caregivers receive treatment literacy support to help them understand HIV and support their children’s adherence to treatment, while adolescents living with HIV participate in peer support groups. Healthcare workers and community outreach staff receive training to strengthen paediatric HIV services, and regular coordination meetings between communities and health facilities helps children move successfully from diagnosis to long-term care.

In addition to service delivery, the project places a strong emphasis on learning and evidence generation. Partners use data and insights from communities and health facilities to identify promising practices, document lessons learned and develop a National Paediatric HIV Risk Intelligence Framework. This knowledge is shared with policymakers and practitioners to strengthen paediatric HIV programmes, inform advocacy efforts and support the scale-up of effective approaches that help more children living with HIV access the care they need.

This project and its partners are part of the Paediatric HIV Partnership.

The project delivers more than services for children in three provinces. It generates practical evidence on what works to identify children living with HIV, connect them to care and keep them on treatment. The lessons, tools and data generated through the project will be shared across the Paediatric HIV Partnership, helping successful approaches be adopted by more organisations, inform policy and reach more communities. In this way, the project’s impact extends far beyond the children directly supported through its activities.

The project is led by the HIV Survivors and Partners Network (HSPN), which coordinates the consortium and implements activities in Gauteng Province. Consortium partner WeCare leads implementation in KwaZulu-Natal, while Zanoncedo Empowerment Centre (ZEC) implements activities in the Eastern Cape. Aidsfonds supports the project as the funding partner and facilitates learning and knowledge exchange across the broader Paediatric HIV Partnership, helping successful approaches reach more children living with HIV.