Find, Test, Treat 4000 children living with HIV

Find, Test, Treat 4000 children living with HIV

Project

The programme is an intervention by SAfAIDS in collaboration with the Ministry of Health and PATA. It is intended to find, test and treat 4000 HIV exposed infants and infected children aged 0-9 years in Zimbabwe. This programme will contribute towards achieving the 95 x 95 x 95 national targets, within the Start Free, Stay Free and AIDS Free and elimination of paediatric HIV by 2022 agenda of the National Paediatric and Adolescent HIV Response.

Project details

Time frame
31 May 2018 - 30 December 2019
Budget
€ 450,000
Active in
Zimbabwe

Objectives

1. Strengthen community systems to enhance early identification, testing and treatment of 4000 children living with HIV aged 0-9 years; pregnant and lactating women before, during and post-delivery. Link them into care to close the gaps in the PMTCT and paediatric HIV response, by 2020
2. Strengthen clinic-community collaborations between multidisciplinary paediatric and children HIV treatment teams, CBOs and communities. Enhance the finding, diagnosis, linking into care and retention of children 0-9 years into paediatric HIV treatment, care and support within programme communities, by 2020
3. Research, document best practices and share lessons learnt on working community approaches for case finding, testing, treatment and retention in care of infants and children 0-9 years and pregnant women in Zimbabwe by 2020

Community groups

Children living with HIV aged 0-9 years
Pregnant and lactating women

Background

The programme is built on the premise that close to 82 000 children in Zimbabwe need to be diagnosed and initiated on HIV treatment, while 7% of pregnant women still deliver at home. While the majority of children in Zimbabwe (93%) are delivered in a hospital or clinic, 89% attend the 6 weeks post-natal care (PNC) clinic, only 56% access diagnosis and treatment for HIV by 6 weeks.

The latter statistic poses a major concern, with 30% children infected with HIV being missed for diagnosis and treatment initiation, who die in the first year of life. This rises to 50% mortality by age two, and 75% by age three. Early diagnosis and initiation on ART can reduce mortality among HIV infected infants by up to 75% . It is therefore imperative that all HIV exposed children be identified, diagnosed and initiated on treatment before 18 months, in order to achieve better health outcomes and attain the national 95 x 95 x 95 paediatric Fast-track targets. The FTT 4000 programme will further expedite mobilisation of the remaining 7% pregnant and lactating women (PLW) to deliver in health centers, and facilitate their access to HIV testing, PMTCT services, testing of the newborn at birth and retention in care thereafter of both the mother and the child for better health outcomes.

Zimbabwe is set to be one of the first African countries to eliminate mother to child transmission despite having one of the highest HIV disease burdens globally. This is a result of the collaborative efforts of multiple and diverse stakeholders, who maintained concerted focus on ending mother to child transmission in the last few years.

Unfortunately, these successes are not uniform at provincial and district levels, and epidata reveals disparities in coverage and reach between districts – with some achieving almost 100% coverage while others are lagging behind. Statistics for the 0 - 14 year age group indicate poor access to early infant diagnosis, against stipulated recommendations in the WHO Guidelines of 2015 that all infected children under 5 years must be initiated on ART at the time of diagnosis regardless of the immunological or clinical staging.

Despite the wide availability of ART, 44% of HIV exposed infants are still lost in the cascade from the diagnosis of the pregnant woman, delivery, PNC and the first 5 years of their lives. Most infants and children tested are captured in the system way after the recommended time period that is from birth to age of one year. If the opportunity for diagnosis is missed at birth, further opportunities may be seized when the child is brought back to the health facility for under 1-year health care, such as immunizations. After the age of 10 months to 2 years, there is a reduction in frequency of health facility visits for child health milestone checks, and HIV exposed children fall through the cracks at a higher probability.

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