Final Report: Activities of the American Academy of Pediatrics in the Zika Program of the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project in the Eastern and Southern Caribbean

Kitts & Nevis, and St. Vincent & the Grenadines—to respond to the increased needs of the newborn and well-child care systems in light of the Zika epidemic. The period of AAP performance was August 29, 2018 – July 31, 2019. Since the outbreak of Zika virus in 2016, the AAP has been a leader in the United States (U.S.) response. The AAP, through its Committee on Infectious Disease, Disaster Preparedness Advisory Committee, and other sub-specialty committees, has been instrumental in advising the U.S. Centers for Disease Control and Prevention (CDC) and partnering with them to develop interim guidance for diagnosis and screening of Zika. The latest evidence on the impact Zika may have on exposed infants was published in a supplement to AAP’s journal, Pediatrics, in February 2018. The AAP utilized a multi-pronged approach to reach both policy and practice levels of the health system. At the policy level, the AAP provided recommendations to the national Zika care guidelines, backed in up-to-date science beyond currently published global and national recommendations from the World Health Organization/Pan American Health Organization (WHO/PAHO) and CDC. At the practice level, AAP developed new surveillance tools and job aids, a training curriculum linking pediatric Zika care to AAP’s Essential Care for Every Baby (ECEB) curriculum, routine well-child care (6 weeks to 6 years), and neurodevelopmental surveillance (NDS), reaching nearly all public child health providers on each island and training a core set of champions for both essential care for every baby and neurodevelopmental surveillance. The AAP employed a multi-disciplinary team of staff and AAP-member consultant experts to implement the USAID ASSIST Eastern and Southern Caribbean activities. Key personnel included Terrell Carter, MHS, Director Global Child & Adolescent Health, who provided overall project oversight and delivered on-the-ground technical assistance. Hannah Foehringer Merchant, MPH, Program Manager Global Child Health Initiatives, provided ongoing technical and programmatic oversight. Beena Kamath Rayne, MD, MPH, FAAP, Essential Newborn Care Advisor, provided curriculum development, in-person technical assistance (TA) and training, and remote technical support. Kera McNelis, MD, MS, FAAP, Essential Newborn Care Advisor, provided technical assistance and training on essential newborn care and neurodevelopmental surveillance. The AAP developed an initial training curriculum in August 2018, which was introduced in September 2018 to provide baseline knowledge on Congenital Syndrome associated with Zika (CSaZ), neurodevelopmental surveillance (NDS), and essential newborn care in each country. In December 2018, the AAP introduced the NDS Tool and trained a cadre of nurses in ECEB in each country. From February to March 2019, the AAP conducted a refresher on the NDS tool, including the introduction of job aids and developing referral pathways for children with developmental delays. A regional learning meeting and introduction of ZiCaMas took place in February to March 2019. Sustainability planning occurred from May to June 2019, and the AAP finalized pediatric care guidelines and clinical decision trees shared with MOHs in July 2019. The updated Zika care guidelines and associated health facility tools were developed and disseminated to the four Ministries of Health. Newborn and well-child care providers were trained to respond to the expanded clinical needs of CSaZ. Country-specific results showed that the AAP's efforts had a positive impact on the health systems in the four Eastern and Southern Caribbean islands. The AAP's multi-pronged approach to addressing the Zika epidemic in the region was successful in improving the health outcomes of children and families affected by the virus.