In October 2015, following the PEPFAR guidance to improve integration of HIV and OVC care programs for improved outcomes for children and their caregivers, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) project set out to support OVC implementing partners (IPs) to strengthen community-facility linkages. To commence this work, ASSIST worked with 10 CSOs that were selected by the IPs in 38 villages in 6 districts.
ASSIST supported the setup of QI teams at the parish and CSO levels. ASSIST also built the capacity of these CSOs to conduct quality supervision. ASSIST used a collaborative approach where we set QI teams at the different levels: CSO and community given that they were both working on different processes of the community-facility linkages. The work started with the CSOs focusing on increasing the proportion of supported beneficiaries (vulnerable children and caregivers) with a known HIV status, then they began identifying HIV positive children in the supported communities who had not yet been reached by their programs. Subsequently, their efforts targeted closing gaps in the processes along the HIV care and treatment cascade ensuring identification, linkage, retention, and viral suppression. To increase HIV testing among OVC program beneficiaries, teams conducted targeted home visits to provide counseling on benefits of HIV testing and conducted targeted community HCT outreaches for the beneficiaries. The find new HIV positives, teams used case finding criteria to identify new HIV positive suspects by community resource persons and provided referrals for HIV testing to the nearest health facility, outreach post and home-based HCT was conducted.
Following implementation of the changes, the percentage of vulnerable children (0-14 years) with a known HIV status increased from 37% in October 2016 to 78% in July 2017 at 10 CSOs. And OVC 15+years with caregivers improved from 35% to 81%. Changes tested include: targeted home visits to provide counseling on benefits of HIV testing and targeted community HCT outreaches. Similarly, the percentage of persons eligible for HIV testing who tested HIV positive reached an average of 54% for children (0-14), adolescent 15+ years, and caregivers by July 2017. Those eligible were identified through use of a screening tool (Appendix I) with children 0-14 as an entry point to the household. On identification of eligible persons for HIV testing, 5community resource persons made referrals to the nearest health facility, outreach testing points, and, in some cases, home-based HCT. Referrals were done with the MGLSD referral form (Appendix II).
This change package illustrates how to improve processes of care for HIV-positive children (including identification, linkage to care, and viral suppression) in the community. It serves as a learning tool for organisations, CSOs, or local government Community Development Officers and any other entities working in the community that can adapt or adopt these suggested solutions to their own settings. The change package includes a “how to” section with detailed explanation of the implementation of the change ideas. Teams may select what they deem as relevant changes, adapt or adjust them as necessary, then test them on a small scale and use data to determine whether implementing those ideas has led to improvement or not. The team should continue testing or adding ideas until the desired level of performance is reached. It is important to note that the improvement teams need to understand the root cause of the challenge they are trying to address to be able to identify an effective change that will close the gaps.