Muzie Yende/Elizabeth Glaser Pediatric AIDS Foundation

The issue
Once a child is diagnosed with HIV infection, there are a number of factors that may contribute to problems with retention in care, antiretroviral treatment (ART) uptake, adherence and poor virologic response, many of which stem from the fact that children are dependent upon adults for attendance at clinic appointments and ART administration. HIV infection in sub-Saharan Africa occurs in the context of the family; however, most HIV and ART services have separate pediatric and adult HIV services, with little attention to family or other social contexts.

Our approach
This study is evaluating the effect of implementing a family-centered model of care program on viral suppression and retention in care among children. In the family-centered care model, after identification of HIV infection in a child, active HIV testing of all family members is conducted, and all HIV-positive family members are seen together as a unit and receive their care together. The two-arm, prospective cohort study is enrolling more than 650 HIV-positive children seeking care at eight health care facilities in Hhohho region (four randomized to offer a family-centered care service delivery program and the other four to continue offering the standard of care with separate pediatric and adult HIV clinics). The children in the study, ages 0–14, are being followed for 18 months.

The impact
Should the model prove to be effective, feasible, and acceptable, the program should be easily transferable to other resource-limited country settings, and contribute to the global UNAIDS/PEPFAR 90-90-90 targets by ensuring viral suppression and care retention among children on ART.