You Are Helping End AIDS 

Thank you for your support and caring. Your support is creating a legacy of healthy families and a scenario where we can end AIDS. The UN Sustainble Development goal for health includes ending AIDS by 2030 which will generate profound health and economic benefits globally. 

Highlights of Progam Activities in 2018

To help end AIDS, we added 50 HIV+ children last May to bring the total to 400 children under our care. The Project Nurse created a personalized health plan for the new children and the focus of our trained health care team is to stabilize and improve the health of these children so that they never develop AIDS.

Our goal is to provide high quality care to 400 HIV+ children, prevent new HIV infections and make families self-reliant in taking care of their health. With better knowledge about HIV, community residents can take steps to prevent new HIV infections and the spread of HIV. This leads to a lower incidence of HIV, reduced stigma, and higher school attendance and performance.

Training in HIV was provided to 53 family members to ensure that all children are under the care of a trained caregiver 24/7. This is supplemented by ongoing training to both children and their primary caregivers. 

Program services: All 400 HIV+ children receive food, medicines and a package of life saving health care services and will continue to do so till they turn 18 years of age. The package of services provided includes regular home visits from community health workers/project nurse, psycho-social counseling, education in HIV prevention, and adherence monitoring and training for older children. In addition, family members are provided with training in basic home nursing, hygiene, HIV care and prevention. Beneficiaries: Direct and indirect beneficiaries are estimated to be 2400 community residents infected/impacted by HIV and AIDS.

Program Impact: All children under our care show a marked improvement in health, attend school and live close to normal lives. 

Cholera outbreak: Zambia went through a severe cholera outbreak from October 2017 to January 2018. We are happy that the excellent training and education in hygiene provided by our health care staff resulted in none of the children contracting cholera.

Psycho-social assessment: A psycho-social assessment by a trained social worker was completed for 130 children last July. Information about the mental health and well-being will help integrate the children into their school and community.

Ongoing Program Activities in 2018

Over the last 14 years, this program has grown, matured, and continues to provide a comprehensive package of lifesaving health care services to 400 HIV+ children and their families in Zambia.

Addition of 50 Children: A customized health plan was created for the 50 new children and they are now stable and/or improving in health. For these children our focus is on stabilizing their health so that they can attend school regularly. In addition, children on ARV medication and older than 11 years, are being monitored and trained in adherence to medication. Our goal for these children is that: (i) they understand and accept their HIV+ status, and (ii) can take medications and visit the clinic on their own. For all children who are on ARV’s, our goal is 100% adherence to the medication protocol.

Training in HIV: Family members (a total of 53) of the new children were provided with a five-day intensive training in basic home nursing, caring for an HIV+ child, psycho-social counseling, and HIV prevention. Training modules are interactive, hands-on, and in the local language as most trainees have never been to school and many do not know how to read or write. This is supplemented by ongoing training during home visits.

Program services: All 400 HIV+ children receive food, medicines and a package of life saving health care services and will continue to do so till they turn 18 years of age. The package of services provided includes regular home visits from community health workers/project nurse, psycho-social counseling, education in HIV prevention, and adherence monitoring and training for older children. In addition, family members are provided with training in basic home nursing, hygiene, HIV care and prevention. Direct beneficiaries are 400 HIV+ children. Indirect beneficiaries are an additional 1950 family members.

Prevention of HIV: Testing and knowing one’s status is the first step toward prevention and spread of HIV. Several hundred community residents were encouraged to go in for voluntary counseling and testing for HIV. 324 family members tested for HIV, and 242 tested positive and are now on treatment.

Zero new HIV infections: Over the last 10 years, we have been running a focused PMTCT (Prevention-of-Mother-to-Child transmission) of HIV program. Over the last seven years, 100% HIV+ women who received PMTCT education delivered children who are HIV free.  

“School Support”: Children from 62 families with very low incomes were provided with funds for school fees and expenses such as uniforms, shoes, and books. Most children are cared for by single moms/aunts with little or no source of income.  

Implementation of EHR: To further improve health outcomes we implemented a simple electronic health record (EHR) system for all children

To sum: Program activities outlined above, have set off a chain reaction of positive outcomes that strengthen the community. For example, better health and improved knowledge leads to a reduction in 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.  In addition, healthier children lead to fewer missed days at school and higher school performance.

What have we learned?

• Knowledge about one’s HIV status 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 for the success of any grass roots program.

About Power of Love’s Pediatric HIV care program

Need and location: The program is located in Matero, one of the largest and poorest compounds in Lusaka, Zambia. Matero has a population of 250,000 to 275,000 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.

Vision, mission, and goals: Our vision is a world where the AIDS epidemic is in continuous retreat, and people living with HIV have access to loving care and treatment in an environment free of stigma and discrimination. Our mission is to make families self-reliant in taking care of their own health. Our goal is to equip families with tools to take better care of their HIV+ children and family members at home, prevent new HIV infections, and the spread of HIV.

What’s different about this program? This program is (i) is comprehensive. It provides support in multiple ways and to multiple family members with the goal of family sustainability, (ii) it teaches self-reliance via multiple trainings and educational sessions, and (iii) is embedded in the community as we have gained the trust of community members.

Typical beneficiaries: Direct beneficiaries are children and women as they have been disproportionately impacted by the HIV and AIDS epidemic in Africa. In Zambia, there are 1.4 million orphans in a population of just 14 million. Most orphans are cared for and live in households headed by an older sibling/aunt/grandaunt/grandmother. Out of the 400 children enrolled only 30% live with both parents; the rest are cared for by single parents, grandparents or relatives who need support themselves.

Measuring success and direct impact of our pediatric HIV care program

Since 2004, more than 700 HIV+ children have benefitted directly, and an additional 6000 children and family members are indirect beneficiaries. 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. Survival rates are around 98%. Over the last 14 years, 17 children died. Statistically this number could be 80 or more children as life expectancy at birth for an HIV+ child is only 4 to 5 years. 

Given below are a few measures of the success of this program.

Health: Over the last year, the diet and nutrition of the vast majority of children has improved leading to increased weight, lower intensity and frequency of infections, and a stronger immune system. In 2018, only two children lost weight and only one had a reduced CD4 count. In multiple instances, opportunistic infections have been prevented/treated at home or the child referred to the hospital for early diagnosis and treatment.

Malnutrition: Provision of high protein soya supplement has gone a long way in reducing the number of children who are malnourished or undernourished. At present, 150 children receive high protein soya supplements; 149 children are undernourished, and only one child is malnourished.

Psychosocial counseling: Our evaluation confirms that psycho-social counseling is critical for an HIV+ child’s mental health. Post counseling children are happier, interact better with peers, and feel a sense of belonging with the community. 

Education in prevention of HIV is provided: With better information, family members go in for testing which is the first step in prevention of HIV. In 2018, 324 out of a total of 386 family members tested for HIV and several hundred more were encouraged to do the same. Out of 324 tested for HIV, 242 tested positive and are now on treatment, which implies that 242 people living with HIV are now poor transmitters of the HIV infection.

Reduction in stigma: Because of better information about HIV there are more open discussions about HIV which leads to a reduction in stigma.

Prevention of mother to child transmission (PMTCT): In the last seven years, 100% of children were born HIV free. To date, 37 out of 38 children were born HIV free, even though they have HIV+ moms and siblings. For a story about twins born HIV free with PMTCT intervention, see page 13.

Monitoring and adherence training: 159 children are aware of their HIV+ status and receive adherence monitoring and training. Because of this training, we have 98% compliance (only two children were not compliant) to medicines. Our goal is 100% compliance as non-adherence can lead to opportunistic infections, drug resistance, and toxicity. As the children grow older, they become more self-reliant in taking care of their own health.

Schooling: An improvement in health due to better nutrition and continuous medical care has led to a higher school attendance and performance. In 2018, 60 children are being supported with funds for school fees, books, uniforms, shoes and school bags.

Screening for cancer/HIV: All caregivers are counselled to go in for testing for HIV and cancer screening.

“Safe Park”: This program is free and open to all children in the community and addresses some of the challenges faced by children growing up in a poor community with a high incidence of HIV, AIDS, and malaria. Every Saturday morning, our staff engages the children in educational games and activities.

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 both the pediatric HIV care and micro loans program.

Malaria prevention: All families receive education on malaria prevention and insecticide treated bed nets. This has led to better knowledge about malaria prevention and a lower incidence of malaria.

“Young Stars”:  The goal of this program is to help children, who come from extremely difficult circumstances, stay healthy and achieve their dream of continuing education after middle and high school. To date four children are enrolled and all four want to join the medical field after high school.

Long term impact: Over the last 14 years, survival rates for children have been approximately 98%, opportunistic infections drop to 20-25% of pre-enrollment levels once the child has been on the program for 4-5 months, there is a marked improvement in malnutrition levels, there is a reduction in stigma associated with HIV, school attendance is higher, and families are more self-reliant in taking care of their health.

Next Steps and Plans for 2018/2019

• Add 50 HIV+ children in April 2019 to bring the total number of children under our care to 450.
• Monitor the academic progress of 60 children provided with school support.
• Track graduates and encourage them to volunteer as mentors for younger children.
• Zero new HIV infections. 
• Expand the skill set of community members via the provision of education and training programs.
• Continue to prevent new HIV infections.
• Continue to provide a comprehensive package of life-saving health care services to HIV+ children.

Conclusion

Our goal is to provide high quality care to HIV+ children, prevent new HIV infections and make families self-reliant in taking care of their health. With better knowledge about HIV, community residents take steps to prevent new HIV infections and the spread of HIV. This leads to a lower incidence of HIV, reduced stigma, and higher school attendance and performance. 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 low education and poverty to being better informed and self-reliant. We are confident that all children under our care will continue to show a marked improvement in health, attend school and live close to normal lives. The ripple effects of our comprehensive approach are significant, sustained and continue to strengthen families in the community.

Thank you! We could not have achieved any of our goals without your support.