Expanded Integrated Management of Pediatric AIDS Care and Treatment (IMPACT)

There are an estimated 1.6 million Zimbabweans living with HIV, over 150,000 of whom are children below 15 years old. Mother-to-child transmission accounts for virtually all new HIV infections among infants in Zimbabwe, with children becoming HIV-positive from their mothers during pregnancy, birth, or breastfeeding.

In order to stimulate demand for and improve access to prevention of mother-to-child transmission (PMTCT) and pediatric ART services, World Education's Bantwana Initiative developed the Integrated Management of Pediatric AIDS Care and Treatment (IMPACT) model in 2009. IMPACT is a community-based program aimed at increasing access to care and treatment for HIV-infected children and providing support to mother-baby pairs.

Building on this model, the Expanded IMPACT Program (EIP) works to both test and assist HIV-positive children to access ART across 17 districts in Zimbabwe through support to 205 health facilities, reaching over 100,000 children a year. With matched funding from USAID and ELMA Philanthropies, EIP trains community health workers to mobilize and educate communities about pediatric ART and how to access treatment. The project connects pregnant women of child-bearing age to PMTCT groups, mother support groups, counselling services, income savings and lending groups (ISALs), and community case workers for follow up and adherence. The program is also training primary care nurses in HIV integrated management, strengthening the capacity of local health services.

Additionally, EIP is currently conducting a randomized control trial (RCT) to test the effectiveness of the IMPACT model on childhood development and HIV status. This intervention package includes early childhood stimulation parenting skills, home visits/case management, and economic strengthening activities for caregivers to be able to afford treatment and transportation costs. By better understanding the program's ability to retain HIV-positive children in pediatric HIV care, World Education/Bantwana aims to contribute to the global evidence base concerning integrated service delivery models for pediatric HIV care.