Success Story: The power of linkages: tackling ART adherence challenges through child friendly services

Stigma is a major barrier to testing and treatment adherence. To address these issues, the Zambia Rising project was implemented in 2013, with funding from USAID/PEPFAR and implemented by Save the Children. The project aimed to ensure that children and adolescents, especially those affected by HIV and AIDS, have access to comprehensive coordinated care. To accomplish this, the project rolled out and monitored a series of activities aimed at improving how children's issues are identified and managed at the national, provincial, and district levels. Working across five provinces and 16 districts, including Namwala, the project built the capacity of existing mechanisms to better coordinate and deliver services for vulnerable children and adolescents. At the district level, the project revitalized District Child Protection Committees (DCPCs) in 16 districts, including Namwala. Prior to the project's interventions, these committees rarely met and had little influence on service delivery for vulnerable children and adolescents. Throughout the project's life, Zambia Rising worked with stakeholders to develop terms of reference for the committee and introduced the concept of the joint district multi-sectoral work plan. The joint district multi-sectoral work plan includes activities from stakeholders across six thematic areas: child protection, food and nutrition, health, economic strengthening, education, and psychosocial support. The work plans are reviewed quarterly to determine if activities have been completed successfully and to identify challenges. In Namwala, a local organization, ZNP+, observed challenges with young people during ART clinic days due to long queues and fears of stigma. To address these challenges, the District Medical Officer, who is the health thematic lead on the DPCP, facilitated a solution to designate a clinic day for adolescents and children and their caretakers. This solution aimed to prevent loss to follow-up by shortening wait times and to make children and adolescents feel less alone and isolated when accessing care. The health thematic lead noted that the change in clinic days has improved clinic attendance and has a positive psychological impact on children and adolescents. Anecdotally, health officials observed improvements in adherence, although it is difficult to measure the exact impact of the change. The success of this solution lies not only in its effectiveness but also in the fact that the district was able to innovate with this idea on its own, without waiting for external guidance. International research has indicated that having adolescent-friendly services is an effective way of promoting adherence. The Namwala DCPC's ability to innovate with this idea demonstrates the value of investing in system-strengthening activities in a decentralized approach.