With funding from PEPFAR and the Children’s Investment Fund Foundation, ICAP at Columbia University Mailman School of Public Health and Kenya’s Ministry of Health are working together to implement the Accelerating Children’s HIV/AIDS Treatment (ACT) Initiative. This program expands children’s access to HIV care, ensuring that infants, children, and adolescents are identified, tested for HIV, connected to care, and receive treatment. In Kenya, an estimated 190,000 children are living with HIV, and multifaceted and aggressive efforts to identify HIV-positive children and improve their health outcomes, are working.
[Photo:Dr. Elaine Abrams]
Because of the ACT Initiative, critical areas including case finding, treatment initiation and clinical and psychosocial support to children and families with HIV, once limited in Kenya, have become more commonplace. Historically, health care for children in Kenya has focused on immunizations and screening for tuberculosis and other infections and HIV testing and counseling efforts were geared towards older patients.
Recent changes in Kenya’s guidelines shifted the age of consent for HIV testing from 18 to 15 years of age. This broke down one of the major barriers to reaching elusive adolescents. Modeled after ICAP’s adolescent HIV package of care, Kenya’s National AIDS and STI Control Program developed a structured approach to improve communication and counseling skills, adolescent mental health evaluations, and sexual and reproductive health programming.
Central to those changes was the start of adolescent-friendly services. ICAP restructured patient services at facilities to have designated days when only adolescents are seen by health care providers. ICAP also trained more than 60 adolescent peer educators who provide one-on-one support and lead support groups of other HIV-positive young people. In addition, a structured mentorship program targeting pediatric and adolescent care is key towards adopting a child-friendly, child-centered approach to their issues. Since the project began, HIV services for adolescents have been launched at over 125 ICAP-supported health facilities in Eastern South and Nyanza provinces.
The results of this multifaceted approach are evident. A year before the ACT Initiative, just over 8,500 children were tested for HIV in Kenya and 150 positive children were identified per month at ICAP-supported facilities. Since ACT, that number rose to over 40,400 children and adolescents tested with over 330 positives per month. Over 91 percent of those found HIV-positive were linked to care.
According to Dr. Elaine Abrams, ICAP’s senior research director, Mailman School professor of Epidemiology and a clinician in pediatric HIV, these numbers are only part of the picture.
“HIV services for children and adolescents are more holistic and everything is connected,” says Dr. Abrams, principal investigator of the ACT Initiative in Kenya. “We’ve established a strong platform to provide the essential services that children and families with HIV deserve.”