The POL team in San Diego would like to say a big thank you for your continued support for the children and families in our pediatric HIV care program in Zambia. Over the last two years, this program has grown, matured, and continues to provide lifesaving health care services to 350 HIV+ children and their families in Zambia.
Program Activities in 2016
Program Expansion: We added 100 HIV+ children in 2016 bringing the total number of children under our care to 350. Every one of these 350 children receive food, medicines and a package of life saving health care services till they turn 18 years of age. The package of health care services includes home visits from community health workers, monthly visits from the Project Nurse, psycho-social counseling, education in HIV prevention, and adherence monitoring and training for older children. A customized health plan for each child has led to survival rates of 98%.
Training Provided to Family Members: 162 family members were provided with a five- day intensive training in caring for an HIV positive child. Most trainees are single moms/grandmothers caring for multiple orphans. In addition, 240 family members have been tested for HIV and several hundred more from the community have been encouraged to go in for voluntary counseling and testing for HIV.
Pilot implementation of EHR: Over the last year we have been testing a simple electronic health record (EHR) system in our clinic. In 2017, our plan is to customize and implement the software so that we can generate better health outcomes for our children.
This program benefits 350 HIV+ children directly, and an additional 1900 children and family members indirectly as families share their knowledge with others. Key program impacts are in the following three areas:
Children’s Health: Four to five months after enrollment, the children stabilize and start improving in health. This is indicated by a reduced frequency and intensity of opportunistic infections, a sustained increase in weight, higher CD4 counts, fewer missed days of school, and better performance at school.
Zero new HIV infections: Over the last six years, we have had zero new HIV infections among babies born in our PMTCT program. Moreover, to date, 33 out of the 34 babies born with PMTCT intervention were HIV free even they have HIV positive moms and older siblings.
A Stronger Community: An improvement in children’s health, and sharing of knowledge by families trained in HIV care and prevention, sets off a chain reaction. Here is what we have observed: improved knowledge leads to a reduction in the stigma associated with HIV which encourages more people to get tested for HIV (critical for HIV prevention and spread). This, in turn, leads to a lower incidence of HIV and fewer deaths due to AIDS. This chain of events make the community stronger.
What have we learnt?
- Knowledge about HIV care leads to its prevention.
- Training family members goes a long way in making the community stronger.
- Enrollment in multiple programs goes a long way in family sustainability.
- Gaining community trust is critical. We have gained community trust and are now embedded in the community.
Need for Power of Love's Pediatric HIV Care Program
Power of Love’s pediatric HIV care program is located in Matero, one of the largest and poorest compounds in Lusaka, Zambia. Matero has a population of approximately 275,000 to 300,000 and is characterized with a high incidence of HIV (prevalence rate of 12% among adults aged 15-49), and unemployment rates upward of 60%. Most residents live on less than a $2 per day – defined as extreme poverty by the UN. Our estimate is that at least 5,000 children in Matero can benefit from a pediatric HIV care program such as ours. For stories of children see Annex 2 on pages 10-11.
Typical Beneficiaries: Direct beneficiaries are children and their caregivers as they have been disproportionately impacted by the HIV and AIDS epidemic in Africa. There are 1.4 million orphans in a population of just 14 million in Zambia. Most orphans are cared for and live in households headed by an older sibling or a grandmother. Further, most caregivers are single moms/grandmothers caring for multiple orphaned children/grandchildren. They range in age from 35 to 67 years of age, have little knowledge of HIV as they may have never been to school, and may not know how to read or write.
Rational for our Pediatric HIV Care Program
Vision and Goals: Our vision is to strengthen communities by preventing new HIV infections, and reducing the devastating impact of HIV and AIDS on families. Our goal is to equip families with tools to take better care of their children and sick family members at home, and prevent new HIV infections and the spread of HIV.
POL’s Pediatric HIV Care Program is Unique
Our program is unique as it targets the family as a unit with the goal of family sustainability, it trains family members, it is comprehensive and is embedded in teh community. We do more than provide hand-outs; our program teaches and trains to build a stronger, more self-reliant community.
Measuring Success and Direct Impact of our Program
Since 2004, more than 600 HIV+ children have benefitted directly and an additional 1900 children and family members are indirect beneficiaries as trained family members share their knowledge with others in the community. With a higher level of care at home, and supported by our health care professionals, most children stabilize and improve in health, 4-5 months after enrollment. A summary measure of the success of this program is a survival rate of 98% for our children. To date, we have lost 14 children; statistically we could have lost 60 or more as life expectancy at birth of an HIV+ child is only 4 to5 years. Given below are a few measures of the success of this program.
Health: Over the last year, the diet and nutrition of all children has improved leading to increased weight, fewer infections, and higher CD4 counts (which is desirable as it can delay the start of antiretroviral medication). In 2016, 149 children gained weight and 52 children had higher CD4 counts; only three children lost weight and two had reduced CD4 counts. Opportunistic infections have been prevented/treated before they can compromise a child’s health. Also, there has been a marked decline in the number, intensity and frequency of opportunistic infections.
Psychosocial counseling: Since, 70% of the children live with extended family or single parents, they need psychosocial counseling. Post counseling children are happier and feel a sense of belonging with the community.
Education in Prevention of HIV: Older children and adults are better informed about HIV, and share their knowledge with others in the community. And with a better understanding of HIV more family members go in for testing which is the first step in prevention of HIV.
Reduction in Stigma: Because of better information about HIV, and improved health of the children there is a reduction in the stigma associated with HIV.
Prevention of Mother to Child Transmission (PMTCT): Over the last five years, 100% of new babies were HIV free. To date, 33 out of a total of 34 children were born HIV free, even though they have HIV+ moms and siblings.
Adherence to Medication and Clinic Visits: We have 113 children who are aware of their HIV+ status (see Annex 2 on page 15). There is 100% compliance to medication and these children collect ARV’s and test results on their own.
Schooling: All children who are eligible are attending school. An improvement in health due to better nutrition and continuous medical care has led to a higher school attendance and performance. In February 2017, 24 children were supported with funds for school fees and expenses. To date 49 children have been provided with such support.
Screening for Cancer/HIV: All caregivers are counselled to go in for testing for HIV and cancer screening. Out of our group of 338 women 276 were tested for HIV, and 211 tested positive. This implies that 76% of the children are being cared for by family members who are themselves HIV+ and may need treatment.
Safe Parks: This program is free and open to all children in the community. Every Saturday morning, children have fun by participating in educational games and activities. Families of children are counselled as needed. A few children who graduated (after they turned 18 years of age) from our pediatric HIV care program become mentors and role models for the younger children. About 70-80 children participate each week and a total of 760 children are enrolled.
Micro Loans: The provision of business training and micro loans has enabled women caregivers to take better care of their families, pay for school expenses, and learn to be self-reliant. About 170 families are enrolled in this program.
Malaria Prevention: Because of provision of bed nets and education on prevention of malaria, the incidence of malaria has decreased. In 2016, only two children contracted malaria, were treated and are doing well. 2000 bed nets and education on malaria prevention was provided in 2016 and our plan is to provide 4000 nets in 2017.
“Young Stars”: The goal of this program is to help a vulnerable child (who comes from extremely difficult circumstances) stay healthy and achieve his/her dream of continuing education after middle and high school. “Young Stars” are provided with bi-weekly mentoring sessions (like the “big brother big sister program” in the US) and the family is provided with funds for rent, clothing and medicines.
To sum, survival rates for children are approximately 98%, opportunistic infections drop to 20-25% of pre-enrollment levels once the child has been on the program for 3-4 months, there is a marked improvement in the malnutrition levels, there is a reduction in stigma associated with HIV, and school attendance is higher. The provision of continuous quality health care and training and support to care givers, has resulted in better health and attendance at school. Finally, the residents of Matero have come to rely on our much-needed health care services and we have become an integral part of this community.
The goal of our program is to equip families with skills and provide them with support during this process. With better knowledge about HIV, community residents can find solutions that work best for them. Continued prevention of new HIV infections has led to a lower incidence of HIV, reduced stigma, more people coming forward for testing, and higher school attendance and performance. Every day we see families, especially women transform themselves from a state of poverty and helplessness to taking charge of their lives and becoming self-reliant. There is a distinct change in the attitude and behavior of the women and children as they become role models for others in the community.
Next Steps and New Projects for 2017
In the next few months our goal is to launch projects that will help prevent new HIV infections, increase the number of HIV+ children under our care, and expand the skill set of the community via several education programs for women and children.
Expected Impact in the Next 12-24 Months
In the next few months we expect more children to:
- Improve in health (via higher weight and CD4 counts),
- Do better at school,
- Interact freely with their peers and family members due to reduced stigma,
- Mentor younger children during “Safe Park” activities, and
- Graduate out of middle, and high school.
In addition we expect that the 100 children enrolled in 2016 will:
- Stabilize in health,
- Fewer children will be undernourished and/or malnourished,
- There will be fewer missed days at school and higher school performance, and
- More children will interact and play with their peers.
Thanks for caring.