Strengthening Community-based Services for Children and Families Affected by HIV: An evaluation of the Zambia Family (ZAMFAM) Program

The issue
As the U. S. President’s Emergency Plan for AIDS Relief (PEPFAR) pivots its focus to care and treatment, there is strong interest in learning to what extent community-based programs—including those focused on orphans and other vulnerable children (OVC)—contribute to achieving the public health goals of getting people tested, enrolled in care if infected, and adherent to treatment.

Our approach
The U. S. Agency for International Development/Zambia-supported Zambia Family (ZAMFAM) project aims to strengthen comprehensive, integrated service delivery and support to children living with, affected by, or vulnerable to HIV and their households. Project SOAR conducted a benchmark survey to document the status of core indicators related to child and household wellbeing in current ZAMFAM beneficiary households in target communities in ZAMFAM’s four project provinces. The study sample included primary caregivers who provide care to OVC in their household, OVC 0–9 years of age (information obtained through the caregiver), and OVC 10–17 years of age (directly interviewed). The study found that a large percentage of OVC caregivers were older women with little or no formal education. A significant percentage of OVC have not been effectively connected to health, administrative, or educational services. Areas of concern are the magnitude of economic and food insecurity faced by OVC households and their families and the limited social-emotional support available to them.

Following the benchmark survey, Project SOAR is conducting a three-year prospective cohort survey with caregivers and children living with HIV (ages 5–17) in Zambia’s Southern and Central provinces. The cohort study uses a non-randomized, quasi-experimental design with program and control areas. Half of the sample consists of children residing in communities served by ZAMFAM and the other half of the sample is from non-ZAMFAM areas. The study aims to determine if participation by HIV-positive children in ZAMFAM activities is associated with greater improvements in child and household well-being indicators, including retention in care and treatment adherence.

The impact
The results will inform the Zambia care and support strategy for OVC and young people living with HIV, improve PEPFAR programming in Zambia, and inform the national and global PEPFAR policy agendas for HIV care and support.