Expanded-IMPACT Early Childhood Stimulation Randomised Control Trial

We evaluated the effects of a two-year multi-component intervention on early childhood development, household economic resilience, and retention in care and adherence to treatment.






2014 - 2018

In Zimbabwe, while 85% of HIV-positive adults are receiving treatment and care, only 44% of children are receiving treatment. We designed the Expanded IMPACT model to support the Ministry of Health and Child Care to accelerate pediatric care and treatment access. The model addresses both demand and supply by strengthening capacity, increasing uptake, and supporting decentralization of services to strengthen local clinic capacity.

While designing and implementing the Expanded IMPACT model in Zimbabwe, we recognized a gap in early childhood care and development, especially for HIV-exposed infants. We piloted an early childhood stimulation (ECS) component through a randomized control trial (RCT). With research partners from Oxford University and the University of Stellenbosch, we are leading the two-year RCT to evaluate the significance of our early childhood stimulation parenting curriculum on HIV adherence for mothers and their babies, as well as the cognitive, emotional, and developmental progress of the child. This package includes childhood stimulation parenting skills, home visits/case management, and economic strengthening activities for caregivers to afford treatment and transportation costs.

By better understanding E-IMPACT’s ability to retain HIV+ children in pediatric HIV care, we aim to contribute to the global evidence base concerning integrated service delivery models for pediatric HIV care. Although the RCT is not yet complete, the early childhood stimulation curriculum and interventions were well received and we are utilizing the curriculum across more programs, notably DREAMS and DREAMS IC. Results are expected in 2018. Due to the initial successes of the RCT package of services, we have scaled up the interventions for all 21 E-IMPACT districts.