Expanded Integrated Management of Pediatric HIV/AIDS Care and Treatment

Virtually all new HIV infections among infants in Zimbabwe are acquired from their HIV-infected mothers during pregnancy, birth, or breastfeeding. In 2015, 84% of pregnant women living with HIV in Zimbabwe received antiretroviral therapy to prevent mother-to-child transmission, but only 54.9% of infants born to HIV-positive mothers received an HIV test within the first two months of life.

Bantwana’s Integrated Management of Pediatric HIV/AIDS Care and Treatment (IMPACT) program ensured that HIV-infected children in Zimbabwe receive treatment and follow-up care immediately after HIV testing. A scalability assessment conducted by MEASURE Evaluation found that Bantwana’s intervention was “largely successful in increasing community linkages to health services” — and that there was “broad support for scaling up the program to additional areas as a successful way to target at-risk children in need of services.”

Building on this experience and the positive findings , interventions were scaled up under the comprehensive Expanded-IMPACT program which tested 460,242 children and linked 10,904 HIV-positive children to antiretroviral therapy (ART). In all, EIP increased pediatric ART coverage from 42% to 99% in 17 districts of Zimbabwe.

Through E-IMPACT, we:

• Trained 3,819 community health workers to mobilize communities for HIV testing and follow up with ART adherence support;
• Linked 62,475 mothers to HIV testing and prevention of mother-to-child transmission services;
• Reached 6,767 mother-baby pairs with early childhood stimulation;
• Retained 4,161 caregivers in internal savings and lending groups, which layer parenting education with financial literacy and savings skills to support their children; and
• Supported the Ministry of Health and Child Care to capacitate 248 primary health care facilities as pediatric ART sites by providing training and clinical mentorship to primary health care workers and incentives through results-based financing.

Recognizing the gap in early childhood stimulation (ECS), especially for HIV-exposed infants, USAID set up the Special Initiative to undertake an independent evaluation of the impact and scalability of ECS interventions conducted in Zimbabwe implemented through E-IMPACT and in two other Southern African countries. A randomized control trial was commissioned through University College London in collaboration with research partners from the Liverpool School of Tropical Medicine, the University of Stellenbosch, and the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) to examine the effectiveness of our ECS model. (See research design here.) The service package includes parenting skills, case management and home visits, and economic strengthening activities for caregivers to afford treatment and transportation costs. The study evaluated the impact of our ECS model on the cognitive development of HIV-exposed babies, as well as the impact of the program on HIV adherence for mothers and their babies and the important role of postpartum mental health.

In the complementary scale-up assessment, MEASURE Evaluation cited the strengths of our ECS implementation, including the comprehensive multisectoral approach and integrated caregiver economic strengthening component, strengthening of existing community structures for improved linkages to and coordination of HIV services, effective targeting and outreach, and community-friendly materials. Overall, the study found broad support for scale-up.