HIV testing and counselling (HTC) is the foundation and gateway for HIV treatment and care. Enormous progress has been made over the past decade in encouraging adults to know their HIV status, however, the coverage of paediatric HIV treatment has lagged behind. The epidemic among children stems primarily from mother-to-child transmission and evidence shows that early infant diagnosis (EID) and early initiation of antiretroviral treatment (ART) in infants with HIV can save lives. While EID and prompt treatment of HIV+ infants are critical components of prevention of mother-to-child transmission (PMTCT) efforts, EID has historically received minimal attention compared to other HIV prevention and treatment services.
Since 2013, The ELMA Foundation has invested in the unfinished business of identifying infants, children and adolescents living with HIV and linking to them to treatment. Among this suite of investments is a 36-month grant to the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) to expand access to HIV testing and treatment in Kenya, Swaziland, and Zambia for children aged 18 months to 19 years old. The programme seeks to increase paediatric testing across all ages and improve linkages to treatment by accelerating implementation of Provider Initiated Testing and Counselling (PITC) for children and the introduction of new Point of Care (POC) Early Infant Diagnosis.
Itad has been contracted to undertake an evaluation of the programme, assessing outcomes to accelerate POC/PITC testing in the three countries and inform future investments and the direction of ELMA’s HIV portfolio.
At the heart of our evaluation design is a Theory of Change (ToC) for the ELMA programme. The ToC unpacks the underlying logic of the programme and articulates the causal pathway from what the ELMA programme does, to the changes it hopes to achieve. We are then testing the ToC through several rounds of evidence generation and data analysis through qualitative and quantitative methods. The data generated is then being analysed systematically and rigorously, first for each country, followed by a cross-country analysis to compare how the programme played out in all three countries. Once data analysis has taken place, we will synthesise findings to draw out key learning and insights with ELMA and EGPAF in a process of co-creation. These will be communicated in a series of presentations, co-creation workshops and reports that will be produced over the course of the evaluation.
We believe this evaluation can contribute to global knowledge on the approach to expanding access to HIV testing and counselling for infants, children and adolescents living with HIV and to linking those living with HIV to treatment, care and support. We are therefore delivering an evaluation that will both generate robust evidence and make the most of opportunities for learning.
Photo Credit: Mia Collis, Elizabeth Glaser Pediatric AIDS Foundation