41. Strengthen and expand case-finding through developing nurturing and enabling environments, integrating testing into orphans and vulnerable children (OVC) programs, adapting and localizing case management tools, and promoting social services.

October 2020

  • In Q2/FY20, CRS OVC programs in 5 countries (through 7 separate projects) provided (PEPFAR) to 740,873 OVC 0-17 years of which 96.9% knew their HIV status (or a test was not required). Out of 74,429 HIV-positive OVC receiving comprehensive services, 99.9% were on treatment.

  • In an effort of having almost all children below 15 years know their HIV status, the Epidemic Control 90-90-90 (EpiC 3-90) project developed the Know Your Child’s HIV Status (KYCHS) strategy which is a subset of index testing targeting only biological children of unknown HIV status from women in the child-bearing age who have been on treatment for more than 3 months.This strategy is now in 66/102 facilities and the project has deliberate plans of rolling out this strategy to 90% of supported facilities.

  • CRS’ OVC programs in Cameroon, Zimbabwe, Uganda, and Kenya have expanded case finding using index testing supported by a case management approach. Working with the index children and caregivers enrolled in collaboration with clinical partners, CRS and partner caseworkers or para-social workers (PSW) conduct home visits and HIV risk assessments for family members of the index client and refer them for HIV testing services (HTS).Caseworkers refer all clients meeting risk criteria for HTS, including index-based testing of all biological children of HIV+ caregivers and biological siblings of CLHIV for whom HIV status is unknown. The PSW and supervisors coordinate with focal persons at the clinic to ensure completion of HTS referral, providing physical escort when necessary. HIV+ children are linked to treatment and adherence support, supported by project social worker, PSW and Linkages Focal Person.

June 2020

CRS: Strengthen and expand case-finding through developing nurturing and enabling environments, integrating testing into orphans and vulnerable children (OVC) programs, adapting and localizing case management tools, and promoting social services.

  • CRS FASTER’s studies on the acceptability, feasibility and effectiveness of caregiver-assisted oral fluid-based HIV screening of children 18 mo – 14 years in Zambia and Uganda are preparing for research assistant training and site activation in August and September, respectively. 

  • In light of PEPFAR’s recommendation to consider HIV oral screening for children 2-11 years in other countries during the time of COVID, FASTER and CDC have been in discussing caregiver-assisted testing of children with a CDC-supported colleagues in another Southern Africa country and have shared specific SOPs and training materials developed for the FASTER Zambia and Uganda studies with them.

  • FASTER is working with EGPAF to provide programmatic assistance with the Ministry of Health in Zimbabwe for the introduction of Raltegravir granules for HIV-positive neonates in 14 select POC-EID birth testing sites. Donated Raltegravir granules from Merck have been pre-positioned at the sites and training of healthcare staff at the sites was completed in mid-June with appropriate COVID-19 precautions. Protocol revisions are being finalized. Final approval and site activation is expected in this next quarter.

 

CRS's FASTER project has begun in Nigeria, Uganda, Tanzania, Zambia, and Zimbabwe (start-up meetings took place and work plans approved in all 5 countries). They are wrapping up protocol development for the Oraquick studies in Zambia and Uganda.

April 2020

CRS FASTER is involved in two studies on the acceptability, feasibility and effectiveness of caregiver-assisted oral fluid-based HIV screening of children 18 mo - 14 years in Zambia and Uganda. But study protocols hindered by COVID-19 at the moment.

 

With PEPFAR recommendation to allow HIV oral screening for children 2-11 years, there will be increased demand for test kits. Many countries will likely have competing priorities for use of their oral-fluid-based HIVST stock if also going to use for screening children.  Many countries only do quantification of need once or twice a year. Implementing this PEPFAR recommendation will require nation MOHs to both 1) update their national guidelines to allow this age group to be tested by their parent/caregiver and 2) look at re-prioritization of available kits and quickly regroup to do quatification to have enough kits available

Other activitie:

  • Supporting the National AIDS Control program to develop rapid advice for HIV programming in the COVID-19 era;

  • Supporting overall HIV program coordination at national and sub-national levels to ensure government support for uninterrupted HIV services at health facilities;

  • Working with lead IPs at the FASTER states to roll out programming strategies to ensure drug availability, drug pick-up and adherence, and uninterrupted uptake of VL and EID testing;

  • Rolling out service delivery models that promote the safety of HCWs and patients and minimizes the transmission of COVID-19 during clinical visits;

  • Promoting use of ICT4D for patient monitoring, appointment reminders, surveillance and monitoring of patients who become co-infected with COVID-19.