The IMPACT model implemented by World Education/Bantwana Initiative Zimbabwe identifies HIV+ children through community volunteers and links them to health facilities for care and treatment. From 2010 to 2013, the program identified 1,974 HIV+ children, with 1,369 initiated on antiretroviral therapy (ART). The expanded IMPACT model will reach an additional 17 districts and target 23,000 HIV+ children with the goal of national scale-up in partnership with the Ministry of Health and Child Care.

1. Dr. Farai Charasika, MBCHB, MSC
Vana Bantwana, World Education/Bantwana Initiative Zimbabwe
Background
Each year in Zimbabwe, 1 in 11 children die before age five from an HIV-related
illness. In 2013, only 42% of children received ART drugs, compared with 85% of
adults. In response to this crisis, the Ministry of Health and Child Care adopted the
national PMTCT Strategy for Eliminating New Infections in Children and Keeping
Mothers and Families Alive (2011-2015). By identifying children living with HIV and
providing them access to treatment, WEI/Bantwana’s Vana Bantwana (VB)
Integrated Model for Paediatric HIV/AIDS Care and Treatment (IMPACT) model
feeds directly into the national paediatric ART priorities. The IMPACT model uses
community-based networks of volunteers to link HIV+ children to health facilities,
thereby accelerating their access to care and treatment.
IMPACT Model
Program Considerations
Evidence suggests that IMPACT’s approach of strengthening linkages
between communities and primary care clinics significantly increases
paediatric ART demand, access, and adherence while offsetting HIV testing
costs. Below are some examples of the contextual challenges
WEI/Bantwana has faced since implementing IMPACT in 2010.
Acknowledgments
World Education/Bantwana Initiative would like to thank PEPFAR, USAID, and the Zimbabwe Ministry of Health and Child Care for their
collaboration on the IMPACT program as well as all implementing partners: HOSPAZ, Seke, Simbarashe, Howard Hospital, and Tsungirirai.
Presented at AIDS 2014 – Melbourne, Australia I Contact: charasikaf@worlded.co.zw
Results
Village
health
worker
during an
IMPACT
follow-up
home visit.
Simbarashe
children’s
peer
support
meeting.
Case care workers during an IMPACT community
sensitisation in Bulawayo.
Over a 4-year period, the IMPACT program has identified 1,974 HIV+ children
and linked them to care and support services. Of these children, 1,369 have
been initiated on ART, and the remaining will have their CD4+ and viral loads
monitored. These children will be put onto treatment when their CD4+ count is
below 500 cells/mm3.
Decentralized Paediatric & PMTCT Services
Financial
barriers
High transport costs impede
children from attending
clinics for ART monitoring,
thereby undermining
adherence.
Invited families to
participate in ISAL
groups to increase
disposable income.
Enrolled volunteers in
income, savings and
lending groups (ISAL)
and provided non-
monetary incentives.
Low levels of
volunteer
motivation
Community volunteers
require support for
transport and
remuneration.
Most program areas lack
food resources, which
compromise nutritional
status of HIV+ children.
Household
food security
Provided community and
household nutrition
gardens.
WEI/Bantwana
Responses
Loss to
follow-up
Post PMTCT mother-baby
pairs were lost due to
inadequate follow-up and
support.
Formed mother support
groups and case
management support for
individual families.
Contextual
Challenges
Stigma and
Exclusivity
HIV+ children and family
members were stigmatized
and shunned.
Led media campaigns for
inclusivity of HIV+ family
members and awareness
for testing and treating
children.
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2009 2010 2011 2012 2013
Number of HIV+
Children
Initiated on ART
Number of HIV+
Children
Identified and
Supported
The Expanded IMPACT Model
Expanding to an additional 17 districts and targeting an additional 23,000 HIV+
children, WEI/Bantwana will provide an integrated approach to paediatric HIV
service provision by increasing demand for services at the community level
and strengthening local health facilities on the supply side. WEI/Bantwana
has recently begun working with the Ministry of Health and Child Care’s AIDS &
TB Unit to refine and expand the IMPACT model. This includes linking the
PMTCT cascade to paediatric care and treatment as well as introducing Option
B+ for HIV+ mothers.
Program Description
World Education/Bantwana (WEI/Bantwana)’s NGO partners engage local clinics to
provide community-based paediatric HIV outreach services including HIV counselling
and testing. Partner volunteers (who include home-based care givers, village health,
and case care workers), sensitize traditional and religious leaders to HIV/AIDS
and mobilize communities to access timely HIV testing for children, as well as
mothers in both pre- and post-delivery. They follow up post-PMTCT mother-baby pairs
and track non-facility births for linkages to the national health system. School-based
health assessments, Early Childhood Development (ECD) Centers, Village, Ward, and
District AIDS Committees, and Child Protection Committees are all engaged to identify
high risk children to mobilize for testing.
Children who test positive are initiated on ARV treatment programs and are supported
by trained volunteers who conduct regular follow-up visits to support nutrition,
education, ensure adherence to treatment, manage opportunistic infections, and
provide psychosocial support (PSS).
WEI/Bantwana uses an established ministry-
approved curriculum to train program
staff and community volunteers.
The program encourages
participation in child PSS
groups and caregiver
support groups that
address economic
strengthening through
savings and lending
(ISAL), andprovide
parenting skills
training.
From 2010 to 2013, a
total of 1,369 children
had been initiated on
paediatric ART through
IMPACT.
A nurse prepares
children for testing in Seke Rural.
The Expanded IMPACT
model will expand to an
additional 17 districts to
reach a total of 25 districts
and will target 23,000 HIV+
children with the goal of
national scale-up in
partnership with the Ministry
of Health and Child Care.
N
e
x
t in 2014
Current districts
Future districts
Establish complete referral
cycle from communities to
facilities.
Poor
coordination
Medical supplies/drugs
and reagents are limited
and do not reach lower-
level facilities.
Build capacity of district health
teams to coordinate the supply
chain.
Continuum
of care
Few linkages from testing
and PMTCT to treatment
programs, leading to poor
paediatric ART retention.
Limited competence and
confidence of health
workers to initiate
paediatric ART.
Staff
confidence
Roll out training, mentoring,
and regular support
supervision for district nursing
officers and community sisters
(Registered Nurses).
Early infant
diagnosis
Limited access to diagnosis
(loss to follow-up, limited
test kits, long turnaround
time for results).
Support timely transportation of
HIV test samples to designated
district-level collection points.
Contextual
Challenges
Expand and strengthen
programming beyond ART
provision to include treatment
literacy, ISAL groups for
caregivers, nutrition education,
PSS, and parenting skills.
Holistic
programming
Need to strengthen links
between paediatric HIV and
other critical wraparound
services.
WEI/Bantwana
Scale–Up Responses