Introduction

Rationale for a Pediatric HIV Care Program: Globally, 17 million children have been orphaned due to AIDS. In 2019, 1.8 million children were living with HIV but only 54% had access to ARV medication. Moreover, life expectancy for a child born with HIV is at best 5 years without treatment. Hence, there is a huge need to provide adequate care to vulnerable children living with HIV and to prevent new HIV infections. However, providing cost-effective pediatric care in resource-strapped sub-Saharan Africa remains a significant challenge.

We can end AIDS: Ending AIDS will generate profound health and economic benefits globally. The African countries will see a significant increase in GDP and ensuring healthy lives and promoting well-being at all ages will put the world on the path to sustainable development as outlined by the UN’s sustainable development goals for 2030.

Program Activities and Achievements in 2020

COVID response and program changes:

To prevent COVID-19, some of the changes made were as follows:

• Provided COVID19 education and PPE (face masks, sanitizers, and gloves) to the families of our ground team and all families enrolled.
• Converted in-person health check-ups to health monitoring via frequent phone calls. During these calls, information on COVID-19 is provided. Children who are sick/critical continue to be visited in person.
• ARV medications are now collected for six months as compared to three months to minimize visits to the government clinic.
• Increased the quanity of food provision to children.

New Program Activities

Clean cooking stoves and training on proper use of stoves was provided to 7,000 vulnerable families. These clean cooking stoves are environmentally friendly, generate less smoke, use less fuel, and cook food faster. This has resulted in lower expenses for fuel and we expect to see improvements in health due to reduced smoke inhalation. In addition, the stoves can be used as an income generating asset if used to prepare food for selling purposes. Our goal is to provide an additional 10,000 stoves to vulnerable families this year.

Ongoing Program Activities

Ongoing program activities include:

• Provision of food (mealie meal, beans, cooking oil) and medicines to 450 HIV+ children.
• Provision of high protein soya supplement to 250 undernourished children.
• Regular health monitoring via phone calls. Children who are sick/critical are visited in person.
• Psychosocial counseling provided to all children. Most children learn about their HIV+ status around the age of 11 or 12 years. Before, during, and post-disclosure the child is monitored closely to check for distress and difficulty in accepting their HIV positive status. 
• Monitoring and training in adherence to medication provided to 256 children who are aware of their status.
• Provision of education in HIV: As of December 2020, 87% of women caregivers were tested for HIV and several hundred more were encouraged to do the same. Out of 377 tested, 308 or 82% tested positive, are on treatment and now poor transmitters of the HIV virus.
• Ongoing training in HIV: Family members (433 in all) were provided with ongoing training in hygiene, HIV care and prevention.  
• Elimination of Vertical Transmission of HIV: To eliminate vertical transmission, HIV+ pregnant women are provided with education to ensure that their newborn infants are HIV free. To date, out of a total of 44 births, 43 children were born HIV free.
• All families provided with long lasting insecticide treated nets and education.  As a result, there were no cases of malaria amongst beneficiaries. 
• School support (tuition, books, uniforms, shoes, bags) was provided to 156 children.
• 7000 families were provided with clean cooking stoves. These stoves have reduced fuel costs and are expected to improve health due to reduced smoke inhalation.
• As part of our outreach activities, children from the community are encouraged to participate in our “COVID education” workshops. Masks are provided. It is free and open to the community. 

Direct beneficiaries are 450 HIV+ children and their families, a total of about 3,000 adults and children. Indirect beneficiaries are an additional 2,200 residents as families enrolled share their knowledge with others. In addition, 7000 families benefitted from the receipt of clean cooking stoves.

Need: About 70% of children live in households headed by relatives or older sibling/aunt/grandaunt/grandmother. Many children suffer from trauma, abuse, lack of food, or grief at losing a parent and are in need counseling. Family members also need support as they lack resources and skills to care for all household members. 

Impact of program activities: Program activities have set off a chain reaction of positive outcomes. For example, better health and improved knowledge leads to a reduction in HIV related stigma which encourages more people to get tested resulting in HIV prevention. This, in turn, leads to a lower incidence of HIV and fewer deaths due to AIDS.  In addition, better health implies fewer missed days at school/work. The result is families more self-reliant in taking care of their health and more sustainable communities. 

Long term impact: Over the last 16 years, survival rates for children were approximately 98%, opportunistic infections dropped to 20-25% of pre-enrollment levels once the child was on the program for 5-6 months, there were marked improvement in malnutrition levels, there was a reduction in stigma associated with HIV, school attendance was higher, and families were more self-reliant in taking care of their health.

Plan for 2021

• Add 50 HIV+ children to bring the total to 500 children and their families. Provide training in basic nursing and caring for an HIV+ child to families of new children.
• Provide clean cooking stoves to an additional 10,000 families. Our goal is to reach 15,000-17,000 families by the end of 2021.  
• Launch a community wide adherence program for adolescents and young adults as adherence rates are lowest for these age groups.
• Launch a program for families to start kitchen gardens in their homes. Training will be provided by professionals.
• Provide food, and lifesaving health care services to 500 children. Provide a higher quantity of food to families.
• Provide funds for school expenses to 160 children and monitor their academic progress.
• Provide long lasting insecticide treated bed nets to all families.
• Stay connected with graduates, support them if needed, and encourage them to mentor younger children.
• Continue to educate women to eliminate vertical transmission of HIV. 
• Expand the skill set of community members via education and training programs.

Building More Sustainable and Peaceful Communities

The comprehensive package of services provided takes care of physical, educational, social, psychological, and income generation, needs of the women and children. Every day we see families, transform themselves from a state of poor health, low education, and poverty to a state of knowledgeable and self-reliance in caring for their health and taking charge of their lives. This results in stronger and more sustainable communities.

Thank you for your gift of health and education to orphans and vulnerable children living with HIV in Zambia.