Maximizing Linkages to OVC ProgramsPEPFAR 3.0 and OVC Programming: Implications and

Promising Practices for ImpactOVC Task Force Meeting. Oct 7, 2015

Brenda Yamba Acting Senior Orphans and Vulnerable Children AdvisorOffice of the Global AIDS Coordinator & Health Diplomacy

OVC Programs link to HIV cascade

CASE FINDING

Keep kids in TREATMENT

cascade

Foster comprehensive

HEALTH

1.

2.3.

HIV infected

HIV Diagnose

d

Enrolled in Care

ART Eligible

ART Initiated

Retention on ART

1. OVC programs can help find the kids in need of HIV/AIDS treatment

1. Case Finding

1. Partnership between clinic/hospital and OVC program in the community– Identify barriers to accessing services– Formalize collaborating strategy for testing kids/families

and bi-directional referrals for other services.

2. Include knowledge of HIV status in the community/household assessment tools.

3. Identify OVC platforms to link with clinical services4. Skilled OVC staff in pretest counseling & follow-up.

OVC Programs link to HIV Cascade

CASE FINDING

Keep kids in TREATMENT

cascade

Foster comprehensive

HEALTH

1.

2.3.

HIV infected

HIV Diagnose

d

Enrolled in Care

ART Eligible

ART Initiated

Retention on ART

2. Keep kids in the Treatment Cascade: OVC programs can help “plug” the leaky HIV/AIDS treatment cascade for

children

Rosen, PLoS Med 2011; Fox, TMIH 2010

2. HOW OVC programs keep children in the Treatment Cascade

Methods proven to increase adherence and retention in children:• Psychosocial Support (child & caregiver)

– Caregiver & women’s support groups – Peer mentoring– Individual support

• Economic Strengthening of family

OVC program examples of results:• In Zim, 100% of HIV+ <5 retained in C&T – very comprehensive• In Kenya, 95% of HIV+ children linked to care & support.

– Some caregivers are undergoing further counseling to enhance acceptance of the results

• In Mozambique, OVC community workers linked family members to social support and clinical services and returned 68% of treatment defaulters to ART/clinic.

What you can do to keep children in the Treatment Cascade

1. Formalize a partnership between clinical and OVC programs

2. Establish referral system for HIV + children and their caregivers to OVC programs that provide:– Psychosocial support for caregiver & children – Economic strengthening activities like Savings groups

3. Train OVC staff/home visitors in referring for testing, treatment, and guidance on tx adherence, monitoring and addressing LTFU

OVC Programs link to HIV Cascade

CASE FINDING

Keep kids in TREATMENT

cascade

Foster comprehensive

HEALTH

1.

2.3.

HIV infected

HIV Diagnose

d

Enrolled in Care

ART Eligible

ART Initiated

Retention on ART

3. Foster Comprehensive Health for HIV + children

Why children affected by AIDS need attention to comprehensive health

Elevated risk of • Mental health issues –

depression & anxiety• School drop-out• Stunting• Developmental delays• Abuse • Death e.g. when a mother

dies, the chance of her child dying within 24 months increases 10 fold.

HOW to Foster Comprehensive Health

• Early stimulation – training for mothers via mother support groups, in-home or peer mentoring

• Economic strengthening (e.g. savings groups) to support improved nutrition and access to treatment

• Nutrition interventions• Psychosocial support, triage• Help kids stay in school and succeed – gives hope

(mentoring, • Building hope and resilience

Contributions to PEPFAR Central Initiatives

DREAMS will maximize the PEPFAR OVC program to mitigate the social effects of AIDS and therefore reduce HIV risk behaviors and risk exposure among adolescent girls through evidence-based interventions including:• Education subsidies• Social asset building• Parenting/caregiver programs• Cash transfers • Combination socio-economic approaches

ACT will maximize the PEPFAR OVC program’s capacity to “strengthen children’s resilience” by:• Addressing socio-economic barriers in vulnerable families and therefore support

increased treatment entry and retention in children and adults• Scaling up evidence-based interventions • Linking community and clinical services • Enhancing family-centered care• Strengthening the measurement of quality improvement, cost analysis, and outcomes.

Parenting/Caregiver Programs

Cash transfers,

either uncondition

al or with schooling

conditions

Combination socio-economic approaches

Educational subsidy

Strengthening the Family

The Core Package

Example: Cameroon Framing OVC Strategy within HIV Care Continuum

15

Health Systems Strengthening

• Core OVC servicesa) Facilitate access to

HIV/AIDS –related clinical services, e.g. HTC, care, and support

b) Household economic strengthening

c) Promote supportive family environment

d) Comprehensive SRH education and condom programming for adolescents.

• Family counseling to facilitate disclosure and client education.

• Food supplements for clinically malnourished OVC

• Core OVC services

• Adherence counseling and psychosocial support

• Food supplements for clinically malnourished OVC

• Core OVC services

• Adherence counseling and psychosocial support

• Case management to

track and refer those LTFU

• Food supplements for clinically malnourished OVC

• Support transition from

pediatric to adult treatment services

• Core OVC services

Core services for OVC OVC found positive Linkage to clinical care

Support for retention and adherence