KidzAlive Model: Best practice in providing holistic HIV testing, disclosure, care and support for children and their families.

Transcription

1 KidzAlive Model: Best practice in providing holistic HIV testing, disclosure, care and support for children and their families. 15 June 2017 Lynnette Murimba - Programme Manager Chipo Mutambo - M & E Manager

2 National Paediatric Testing, Disclosure, Linkages & Adherence Services for Children

3 Overview This Presentation covers the following: Introduction Role of Zoë-Life Impact on children's health outcomes Lessons Learnt

4 Introduction KidzAlive is a model adopted by NDoH strategy to support: The increase in case-finding HTS and disclosure services Linkages to care Adherence Comprehensive Care and Support Integrates TB and Integrated Management of Childhood Illnesses(IMCI) Is aligned to the Adherence Guidelines(AGL) Provides age appropriate tools to improve retention in care Assists in the creation of child-friendly spaces

5 WE WANT.. Children living with HIV to be Healthy

6 Children living with HIV to be Healthy Identify early (HIV, TB, Malnutrition) Get onto ART, TB prophylaxis and Rx Retain in care Adhere to Treatment and OI prophylaxis Case finding in high burden communities and facilities Kids in key entry points IMCI, TOP, FP, Wards, POPD Kids in community hotspots OVC, Phila Mntwana, DREAMS Improve staff confidence Strengthen linkages & referrals PCR Rapid tracing Disclosure Rapid high VL return to care Home visits Adherence platforms

7 WE are GOOD at SYSTEMS and PROGRAMMES BUT we STILL FAIL Because the SYSTEMS and PROGRAMMES must meet the CORE needs of PEOPLE

8 Do we know why this is so hard? 1. The most common reason given by Caregivers who avoid bringing children in for testing is FEAR of DISCLOSURE 2. The most common reasons given by Health providers on why they avoided testing or disclosing to children were lack of skills and tools resulting in FEAR.

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13 Role of Zoë-Life Capacity building Systems strengthening Strengthening of Child Friendly Service Provision at community and facility level Tracking of KidzAlive Trainer of Trainer (TOT) cascade, providing training and mentorship for implementation. Development of programme monitoring tools to assess implementation progress Monitoring paediatric data elements on Tier.Net, DHIS and DATIM to assess improvement

14 KidzAlive Training Coverage

15 Child-Friendly Spaces Created 60 Number of Child Friendly Spaces Created in CBOs and Health Care Facilities in South Africa March 2016 March Number of Sites DoH Facility DoH Facility CBO DoH Facility DoH Facility DoH Facility DoH Facility DoH Facility DoH Facility HST HST HIVSA The Aurum Institute 1 3 HST MSF Broad Reach ANOVA The Aurum Institute Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo North West

16 Example of Child-Friendly Spaces Created in KZN 7jRkTvgo

17 Contribution to the 1 st 90: Knowing Your HIV Status Number of children who received HIV Testing Services (HTS) and received their test results Health Care Worker (HCW) confidence in working with primary caregivers (PCG) is enhanced through training and mentorship. This contributed to an increase in the testing of children and caregiver s subsequent increase in confidence to test their children for HIV. KidzAlive components: Family Support Intervention (FSI) Foundations on HTS, Disclosure and Adherence with Children (FHDA)

18 Contribution to the 1 st 90: Knowing Your HIV Status Number of children who received HIV Testing Services (HTS) and received their test results HIV Test Child <15 Years and HIV Test Positive Child <15 Years in 14 FHDA Trained Facilities in Chris Hani District (Quarterly) Number of Children FHDA Training Oct to Dec 2015 Jan to Mar 2016 Apr to Jun 2016 Jul to Sep 2016 Oct to Dec Data Source: DATIM through HST HIV Test Child <15 HIV Test Positive Child <15

19 Contribution to the 1 st 90: Knowing Your HIV Status Number of children who received HIV Testing Services (HTS) and received their test results HIV test child 19 Months -14 years in Thokozani Clinic in King Cetshwayo District (AGL Mini Rollout Learning Site) (Monthly) Number of Children FHDA Training Mentorship/ Site Visits Started MMC Campaign Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Data Source: DHIS HIV test child 19 Months -14 years HIV test positive child 19months -14 Years

20 Contribution to the 2 nd 90: Treatment Initiation Number of children newly enrolled on antiretroviral therapy Child under 15 years started on ART during this month naïve in 23 FHDA Trained Facilities in uthukela District (Monthly) Number of Children FHDA Training Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Data Source: DHIS Child under 15 years started on ART during this month - naive Median

21 Contribution to the 2 nd 90: Treatment Initiation Number of children newly enrolled on antiretroviral therapy Disclosure Services Provided vs Child under 15 started on ART during month naïve in Thokozani Clinic in King Cetshwayo District (AGL Mini Rollout Learning Site) (Monthly) Number of Children FHDA Training 0 4 No Disclosure Register available until July Mentorship/ Site Visits Started 1 Disclosure Register implemented in July 2016 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct Disclosure support to caregivers only (non disclosure) Paediatric Disclosure Register Partial Disclosure Provided to Child Paediatric Disclosure Register Full Disclosure Provided to Child Paediatric Disclosure Register Child under 15 years started on ART during this month - naive Data Source: DHIS Complex Disclosure Paediatric Disclosure Register

22 Contribution to the 2 nd 90: Remaining on Treatment Number of children currently receiving antiretroviral therapy (ART) Child under 15 years remaining on ART at end of the month 23 FHDA Trained Facilities in uthukela District (Monthly) R² = Number of Children FHDA Training Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Child under 15 years remaining on ART at end of the month - total Expon. (Child under 15 years remaining on ART at end of the month - total) Projected Trend Baseline September 2015 to June 2016

23 Contribution to the 2 nd 90: Remaining on Treatment Number of children currently receiving antiretroviral therapy (ART) Child Remaining on ART at end of month in Thokozani Clinic in King Cetshwayo District (AGL Mini Rollout Learning Site) (Monthly) Mentorship/ Site Visits Started Number of Children FHDA Training R² = Child under 15 years remaining on ART at end of the month - total Actual Trendline Child under 15 Remaining on ART Projected Baseline before mentorship (October June 2017

24 Lessons Learnt Mentorship: to enhance successful implementation, onsite mentorship support is vital, evidenced by the improvement in health outcomes in facilities where this was provided. Collaboration: to prevent duplication of services and to enhance sustainability of programmes it is essential to foster a culture of collaboration between stakeholders supporting the DOH. This will prevent staff from feeling overwhelmed by multiple programmes with similar objectives. Taking Ownership: Improvement of paediatric health outcomes has been noted in facilities where facility managers have adopted and driven the implementation of KidzAlive. This suggest that for effective scale up of KidzAlive across South Africa the DOH would need to drive the process of implementation.

25 Lessons Learnt Capacity building it is not always possible for Zoë-Life to determine or influence the selection of cadres invited or arriving for training. This results in the training of cadres unable to deliver the services for which they have been trained due to their scope of work being outside of the service. This results in reduced implementation success and, at times, fruitless and wasteful expenditure. Flexibility of KidzAlive to the facility and community setting Zoë-Life has supported the implementation of KidzAlive in health facilities and CBOs. Through the DOH Support Partners (Anova Health Institute, HIVSA and CaSIPO) OVC programmes have enhanced their services with the addition of KidzAlive.

26 Thank You