Community interventions supporting children affected by HIV in sub-Saharan Africa: A review to derive evidence-based principles for programming1

Abstract

Approaching 20 years after the first studies drew attention to the issues faced by children and families affected by human immunodeficiency virus (HIV), evaluation data from programs addressing their circumstances remains limited and clustered, especially when considered in relation to the magnitude of donor spending. A review of evaluation evidence was conducted to derive programming principles for interventions supporting HIV-affected children in sub-Saharan Africa, including care and support, cash transfer and HIV-prevention interventions. Methodologies of existing evaluations reflect diverse aims and research questions, and inconsistent geographical and thematic coverage. The quality of evidence was most rigorous for HIV prevention and least rigorous for care and support, and the resulting lessons learned were correspondingly variable. Evidence across the three intervention types supports several practical strategies and cross-cutting principles to guide intervention delivery, including the importance of formative research and locally tailoring interventions; community and child participation; working directly with women; multifaceted targeting strategies; actively addressing stigma; and careful oversight and monitoring of program implementation. Further efforts to build field staff capacity in monitoring and evaluation and to strengthen program management information systems are a necessary investment in building a sound evidence base to improve programs and effect tangible quality of life improvements for children and families.