Understanding the situation of the continuum of care for children and adolescents living with HIV and AIDS in four PEPFAR scale-up districts in Zambia

The project aims to improve Community-Based HIV and AIDS Care and Treatment towards the achievement of the 90-90-90 UNAIDS targets and an AIDS Free Generation. The project is conducted in collaboration with Boston University (BU) and the Zambian Centre for Applied Health Research and Development (ZCAHRD) Limited. The project focuses on the Continuum of Care for children (0-18 years) and adolescents (10-19 years) living with HIV and AIDS in four PEPFAR scale-up districts. The study reports the results with the aim of distilling community actions that are necessary to contribute to Zambia's quest to reach the 90-90-90 targets. The key to a successful continuum of care is having effective linkages between community and facility levels of service delivery. Community-based HIV Case Finding is one of the key pillars of the project. The study found that community-based HIV testing using trained lay counsellors targeting adolescents is a strategy that is working well in increasing HIV testing uptake. Respondents recommended training adolescents themselves as lay counselors so that they can more easily reach their vulnerable peers with HIV testing. However, stigma and discrimination continue to pose challenges to reaching infants, children, and adolescents through community-based HIV testing strategies. To combat stigma and discrimination, respondents recommended integration of HIV testing services with community-based growth monitoring programs and immunization outreach programs for children. Community-based agents like Community Health Workers (CHW) and other members of Neighborhood Health Committees (NHCs) conduct growth monitoring activities and could concurrently do HIV testing if trained to do so. The study also found that Area Coordinating Committees (ACCs), Community Welfare Assistance Committees (CWACs), and Community Development Assistants (CDAs) were either not involved or under-utilized in community-based HIV testing strategies. The study highlights the importance of effective linkages between community and facility levels of service delivery. Patients from facilities end up in the community, and from the community, they go back to the facilities. Therefore, a successful continuum of care requires collaboration and coordination between community and facility-based services. The study's findings and recommendations are presented within the context of other current evidence from literature. The results are framed into three pillars of the HIV/AIDS Continuum: Community-based HIV Case Finding, Linkage to ART, and Retention in Care. The study aims to contribute to Zambia's quest to reach the 90-90-90 targets and achieve an AIDS Free Generation. The project's focus on community-based HIV Case Finding is a critical component of the continuum of care. The study's findings suggest that community-based HIV testing using trained lay counsellors targeting adolescents is a strategy that is working well in increasing HIV testing uptake. However, stigma and discrimination continue to pose challenges to reaching infants, children, and adolescents through community-based HIV testing strategies. To address these challenges, the study recommends integration of HIV testing services with community-based growth monitoring programs and immunization outreach programs for children. Community-based agents like CHW and other members of NHCs conduct growth monitoring activities and could concurrently do HIV testing if trained to do so. The study also highlights the importance of effective linkages between community and facility levels of service delivery. The study's findings and recommendations have implications for policy and programming in Zambia. The study suggests that community-based HIV Case Finding is a critical component of the continuum of care, and that effective linkages between community and facility levels of service delivery are essential for achieving the 90-90-90 targets and an AIDS Free Generation.