USAID/Ethiopia’s President’s Emergency Plan for AIDS Relief (PEPFAR) program has achieved significant success in preventing and responding to HIV among children. Programs for children orphaned and made vulnerable by HIV (OVC) help HIV-positive children and adolescents begin and maintain treatment and improve viral suppression -- a key component of decreasing transmission. To date, these programs have successfully enrolled 99 percent of HIV-positive children and adolescents in the OVC program into multi-month dispensing (MMD). MMD provides antiretroviral therapy (ART) in three- or six-month supplies, which leads to increased treatment adherence and retention, decreased clinic and staff burden, and decreased costs for clients (including travel time to and from the clinic).

Aynete Afa and daughter Mignot Abebe, both enrolled in USAID’s OVC programs sitting by their home in Arbaminch town of SNNPR, Ethiopia

Photo Credit: Befikadu Dawit, HIV/Health Linkage Coordinator for FHI360 based in Arbaminch, SNNPR.

During the COVID-19 pandemic, USAID’s programs were impacted due to school suspensions, and reduced face-to-face training, events, and a pause on home visits. International and local partners including the African Network for the Prevention and Protection Against Child Abuse and Neglect and Hiwot Integrated Development Organization (and others) recognized that this was a critical time to ensure continuity of care and treatment for HIV-positive children and adolescents, and stepped up to the challenge to deliver this critical support in a challenging time.

USAID partners modified their approaches to maintain HIV programmatic efforts while being responsive to COVID-19 restrictions. OVC partners counseled a majority of OVC beneficiaries by phone and, as necessary, through home visits while adhering to COVID-19 prevention precautions like social distancing and wearing masks. Through these virtual and in-person visits, children and adolescents enrolled by USAID OVC partners learned about their eligibility for MMD. Dispensing MMD and conducting tele-counseling helped to reduce the frequency of client travel to facilities to pick up medication as well as the burden on and volume of clients in those facilities -- thereby decreasing the risk of COVID-19 transmission. As of August 2020, there were no reported COVID cases among any OVC program clients--a remarkable achievement.

Despite the ongoing challenges posed by the COVID-19 pandemic, USAID partners improved HIV testing among children, and enrolled increasingly more HIV-positive children and adolescents in OVC programs, including MMD. By July, 90 percent of HIV-positive OVC adolescents and children received three- or six-month MMD, reaching 98 percent by August, and 99 percent in September.

USAID-supported OVC coordinators and social service workers are key to this success. They regularly meet with HIV-positive children and caregivers to confirm their access to HIV medication and wellbeing. OVC coordinators and social service workers assess daily and weekly MMD targets and collect information from facilities on progress.

Additionally, working in coordination with OVC partners, health facility HIV service providers who monitor MMD targets, also identify HIV-positive children and adolescents who missed appointments or who are no longer enrolled in treatment regimens.They provide this list of beneficiaries to the OVC community providers, who work to find and support the return of these children to care.

The OVC community providers also address gaps, such as identifying missed doses during visits with families and providing medication pick-up reminders to beneficiaries to promote adherence and retention in care. OVC staff conduct frequent meetings to identify issues and analyze data on clients enrolled in MMD to help them better understand and support their clients.

The COVID-19 pandemic has raised unexpected barriers for people living with HIV but the fight against the HIV epidemic and access to life-saving treatment for children and adolescents cannot pause. USAID’s investments in Ethiopia’s PEPFAR OVC programs are an example of how activities can pivot to sustain and accelerate progress, increasing access to HIV medication and supporting clients to stay on treatment -- helping them to lead healthy, productive lives.