POL Posts: Blogs, Reports & Updates
March 9, 2024

Achievements of Children and Families Enrolled in POL's Pediatric HIV Care Program in Zambia

Executive Summary

Thank you! The Power of Love team and our Zambian families are grateful for your support for our pediatric HIV care program in Zambia. Your continued support and love over the last several years is building a community of healthy, well-informed children, and families self-reliant in taking care of their health.

Impact of COVID: A recent report by UNAIDS concludes that during COVID and other global crises, progress toward health targets has slowed and millions of lives are at risk. These findings imply that the UNs goal to end AIDS by 2030, will not be met unless spending on HIV prevention and healthcare services is accelerated.

Rationale for a Pediatric HIV Care Program: Globally, 17 million children have been orphaned due to AIDS and 83% live in Sub-Saharan Africa. In 2021, 99,000 children died of AIDS related causes and 2.4 million children were living with HIV but only 52% had access to treatment as compared to 76% for adults. Children fall through the cracks in accessing treatment. Moreover, life expectancy for a child born with HIV is at best 4-5 years without treatment. Hence, there is a continuing need to provide adequate care (including food) to children living with HIV and to prevent new HIV infections.

About Zambia and its children: Zambia is a democratic country, rich in mineral resources and a young population (53% of its population is under the age of 18 with a median age of 17 years). In addition, most of its estimated one million orphans live with grandmothers/extended family who have little knowledge of HIV and no source of income. However, considerable progress has been made in reducing vertical transmission of HIV with over 90% of pregnant women on treatment.

Our response: Recent studies conclude that the provision of food, clean energy, education, health, water, and sanitation can reduce the impact of climate change and poverty while boosting human well-being. The goals of poverty alleviation and mitigating climate change need not be in conflict. Accordingly, over the last two years our focus has been on monitoring the health of families and school progress of children, tracking, and referring graduates (children who are >18 years or completed high school) to vocational/university courses, and education for families. This approach has gone a long way towards family sustainability and self-reliance.

Plan for 2024: Our plan is to continue to provide a comprehensive package of health care services to 500 children and their families, train family members, monitor the academic progress of children, track graduates, and increase skill levels of community members. Also, safe water filtration systems will be provided to families who do not have access to clean water.

Program Need, Achievements, and Next Steps 

Impact of COVID: A recent report by UNAIDS concludes that during COVID and other global crises, progress against HIV prevention has slowed and millions of lives are at risk. In 2021, new HIV infections fell by just 3.6%; the smallest drop since 2016. In Asia and the Pacific, new HIV infections are rising where they had been falling for the past 10 years. Teenage girls and young women are especially vulnerable. These findings imply that the UN's goal to end AIDS by 2030, will not be met unless spending on HIV prevention efforts is accelerated.

Global HIV status: In December 2020, UNAIDS set up new targets (regarding HIV treatment and education) so that AIDS can be eradicated by 2025. This goal seems ambitious and unlikely to be met by 2025.

Need and Location: The ongoing pandemic has magnified the need for a comprehensive pediatric HIV care program for several reasons. In Sub-Saharan Africa only 52% of children living with HIV (as compared to 76% adults) were on treatment as:

  • Children rely on their caregivers for access to treatment,
  • Pediatric doses are more likely to be out of stock (happened during COVID),
  • It is much more difficult to track and treat children,
  • Children are not a priority as they do not spread HIV,
  • It is not standard practice to test all children and,
  • COVID aggravated the situation with supply disruptions for all drugs and taking away attention from HIV and AIDS.

In Zambia, 59% of children live in poor households with 45% living in extreme poverty, and 35% of children under five have stunted growth. Most of Zambia’s estimated one million orphans live with grandmothers/relatives. Many children suffer from trauma, abuse, lack of food, or grief after losing a parent, and are in need counseling. Also, 800,000 school age children are not in school. Family members need support as they lack resources and skills to care for children and other household members.

Program Beneficiaries: Current beneficiaries are 500 HIV+ children and their families, a total of about 3,500 adults and children. Indirect beneficiaries are an additional 2,200 residents as families share their knowledge with others. In addition, 8,100 families benefitted from the receipt of clean cooking stoves. For stories of children, see page 8.

Ongoing Program Activities and Impact in 2023:

  • 30 family members received training in basic nursing and HIV care.
  • 30 new children were enrolled to replace the 30 children who turned 18 years of age.
  • Provision of food (mealie meal, beans, high protein soy supplement, cooking oil) and medicines to 500 HIV+ children.
  • Regular health monitoring via in-person visits/phone calls. During these visits, in addition to regular health check-ups, education on disease prevention is provided. Last year, all children improved in health as measured by an increase in weight, better immune systems, and drop in viral loads. Ninety eight percent (492/500) children have an undetectable viral load.
  • Provision of education in HIV/STI’s has resulted in practicing safe sex, and fewer STI’s and teen pregnancies. The result is better health, higher school attendance and high school graduation rates.
  • Provision of psychosocial counseling. This is critical as only 31% of children live in households headed by one or both parents. These children suffer from trauma, abuse, lack of food, and/or grief after losing a parent. Family members also need counseling as they have limited resources and may be sick themselves.
  • School support (tuition, books, uniforms, shoes, bags) was provided to 283 children in 2023. Currently, 92% of school-age children are attending school. Our goal is for this number to be 100% this year. Our focus is the health and academic progress of children. Over the last two years (2022-2023), 74% of children in grade 12 graduated high school. This compares well with the national pass rate of 69%. The children who did not graduate high school or dropped out before grade 12 were encouraged to enroll for vocational training.
  • Disclosure process: A strict disclosure protocol is followed to ensure that the children are better adjusted to their HIV status, understand the importance of adherence to medication, and do not miss taking their medication every day. Before, during, and post-disclosure children (typically 10-12 years old) are monitored closely for distress and behavior changes that could lead to missing medications and a negative impact on health.
  • Monitoring and training in adherence to medication provided to 396 children who are aware of their HIV status and to family members.
  • Education in HIV: Last year, 94% of women caregivers were tested for HIV and several hundred more were encouraged to do the same. Out of 448 tested, 392 or 88% tested positive and started treatment. This results in HIV prevention as the women on treatment are poor transmitters of the HIV.
  • Ongoing training in HIV: Family members (478 in all) were provided with ongoing training in basic nursing, hygiene, and HIV care and prevention.
  • To reduce 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 52 births, 51 children were born HIV free.
  • All families were provided with long lasting insecticide treated nets and education. As a result, there were no cases of malaria amongst beneficiaries. 
  • All families who received clean cooking stoves, have improved in health due to reduced smoke inhalation and are saving on fuel costs. To date, 8100 stoves that are environmentally friendly with zero carbon footprint have been provided.
  • More than 900 children benefitted from “COVID education” workshops. The workshops are free and open to the community and masks are provided. Since 2020, a total of 2,500 children and their families have benefitted.

Long term Impact: All children show an improvement in health (5-6 months after enrollment), and with better health more children attend school. For example, 98% of children have an undetectable viral load and 92% of school age children are in school. Over the last 19 years, survival rates for children are approximately 98%, and opportunistic infections (such as rash, cough, diarrhea, TB, and pneumonia) dropped to 20-25% of pre-enrollment levels.

To sum, program activities listed above have set off a chain reaction of positive outcomes. For example, better health and improved knowledge leads to a reduction in stigma which encourages more people to get tested resulting in HIV prevention. In addition, better health results in fewer missed days at school/work and more stable incomes. The result is more self-reliant families who can take better care of their health.

Plan for 2024

  • Provide safe water filtration systems to 700 families who do not have access to clean water.
  • Train family members in basic nursing and in caring for an HIV positive child.
  • Ensure that all school-age children are in school. Increase school support (fees, uniforms, bags, and shoes).
  • Provide long lasting insecticide treated bed nets to all families.
  • Stay connected with graduates, connect them to vocational/professional/university courses, and encourage them to mentor younger children.
  • Educate more pregnant women in elimination of 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 families. Every day we see families transform themselves from a state of poor health, low education, and poverty to being informed and self-reliant in caring for their health and taking charge of their lives. The result is communities that have better skills, improved gender equity, and family sustainability. 

 

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