Strengthening Pediatric Case Finding Utilizing Community and Facility Approaches

This is a continuing activity from FY07. The African Network for Care of Children Affected by HIV/AIDS

(ANECCA) is a network of pediatric HIV experts with extensive experience in pediatric HIV care and

treatment throughout Africa.

The number of children on ART in Ethiopia is extremely low compared to the estimates of children infected

and as a percentage of all people on antiretroviral treatment (ART). An important activity that will increase

these numbers is identification and referral of HIV-positive children at health centers.

ANECCA will provide site-level technical assistance to primary healthcare units (i.e. health posts and health

centers) in selected health networks. ANECCA will build human resource capacity through the following

activities, including training of health providers:

(a) Formal training of various categories of healthcare providers within the health centers. The aim is to

equip the providers with knowledge and skills in the identification of HIV-exposed infants, identification of

HIV-positive children (through routine counseling and testing, etc.), provision of care and treatment services

for HIV-positive children, and utilization of referral networks to close gaps in the continuum of care for

exposed and infected children and their families

(b) On-the-job training of healthcare providers by a clinical mentorship team, comprised of a pediatrician,

nurse, nurse-counselor and a laboratory technician, to cover all aspects of pediatric diagnosis, care and

treatment

(c) Supervised preceptorship at specialized higher levels of care (e.g., hospital pediatric ART sites) - once a

year for each team

ANECCA will promote the identification of HIV-exposed and infected infants/children:

(a) To establish and strengthen linkages between PMTCT, maternal-child health (MCH), and other routine

child health services at health centers. This will promote identification and follow-up of HIV-exposed infants.

(b) Establish and strengthen routine HIV-testing services at health-center level, using HIV antibody testing

to identify exposed infants less than 18 months of age, HIV antibody testing to identify HIV-positive children

at age 18 months, and DNA PCR testing using dried-blood spot (DBS) to identify HIV-positive infants less

than age 18 months. This will be done by providing HIV-testing logistics support, establishing laboratory

referral networks and specifically training health workers at the sites in conducting antibody tests and

collecting, referring, and transporting DBS specimens to hospital DNA PCR sites.

(c) Promote use of Ethiopia National Pediatric and Adult HIV Testing guidelines within the health centers.

Assist IntraHealth in providing a comprehensive basic pediatric care package to HIV-positive children.

ANECCA will provide professional development activities for health providers which are necessary to

provide a basic service package to HIV-positive children. The basic package includes the following:

(a) Early identification of HIV-exposed children within the facility-based services, as well as the community.

The latter will involve the strengthening of health center-community links.

(b) Follow-up for exposed infants: cotrimoxazole preventive therapy (CPT), support for safe feeding

practices, growth and development monitoring, and HIV testing services (DNA PCR and HIV antibody tests)

at the appropriate time

(c) Provision of routine child-survival best practices for HIV-exposed/positive infants/children: routine

immunizations; use of insecticide-treated mosquito nets; safe water use, screening for tuberculosis (TB) and

provision of isoniazed prophylaxis for those exposed to active pulmonary TB;

(d) Routine HIV testing (antibody test and/or DNA PCR DBS - as appropriate) for infants and children

accessing care for poor health within facilities or those identified in the MCH clinics who exhibit signs of HIV

infection, such as growth faltering

(e) Nutrition education, support for food supplementation, counseling and support for safe infant-feeding

practices for HIV-exposed infants as well as supplementation with vitamins and micronutrients

(f) Appropriate and timely referral for pediatric ART services: health workers will be equipped with skills to

evaluate clinically, and with laboratory tests where available, HIV-positive children and refer them for ART at

the appropriate time

(g) Establishing and strengthening referral mechanisms between the community and health centers as well

as between health centers and higher levels of care. Follow-up and referral guidelines will be instituted.

(h) Establishing community outreach services specifically targeted at mothers/caregivers and expectant

mothers' support groups. Issues to be addressed by these will include pediatric HIV treatment awareness,

pediatric ART adherence promotion, support and monitoring, stigma reduction, reproductive health and

family planning services, as well as assisted delivery

(i) Treatment of opportunistic infections as well as other childhood illnesses in children who present to the

health center with these conditions

(j) Provision of psychosocial support services to infected children and their families

(k) Provision of HIV infection-prevention services to caregivers and parents as well as HIV-positive children,

specifically addressing adolescent issues.

ANECCA will also strengthen referral mechanisms at health-center level:

(a) Referral of family members for HIV testing at counseling and testing service points. For some of the

health centers, counseling and testing for children and their family members will be carried out within the

health centers. Referral from their communities to the health centers will be enhanced by strengthening

referral links between the two

(b) Referral of HIV-positive children from health centers to higher levels of care where they will access

pediatric ART services;

(c) Strengthening cooperation between communities and health centers to develop stronger community-

level activities with traditional birth attendants and health extension workers

This will further strengthen referral activities from communities to health centers and vice-versa.