The development of HIV-related mental health and psychosocial services for children and adolescents in Zambia: The case for learning by doing

Abstract

The success of antiretroviral therapy (ART) has sparked a global commitment to strengthen health systems for an improved response. The response, however, is largely biomedical. Far less attention and funding exist for mental health and psychosocial support services (PSS). While the evidence-base for these services is less developed, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has responded to glaring needs through a “learn by doing” approach. This paper documents lessons learned as we responded to expressed needs for child-centered HIV support in Zambia.We formed a multidisciplinary working group to improve support for children on ART. In collaboration with the Zambian Ministry of Health (MOH) and with support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), we began, in 2008, by implementing a pediatric HIV counseling course focusing on disclosure, adherence, and stigma. Play therapy and adolescent-support programs followed. In 2013, with funding from the Conrad N. Hilton Foundation, EGPAF established HIV and developmental delay centers.Through working with the Zambia MOH, we have forged a national response. This involved training pediatric HIV counselors, play therapy counselors, adult mentors and positive peer mentors, as well as clinicians and volunteers in HIV and early childhood development. We have learned that providing health workers with skills to dialog with HIV-affected children and families in honest and developmentally-sensitive ways yields results. Thousands of children have been reached and improved adherence and acceptance of one's status have been reported. Non-medical services have been developed by busy practitioners to meet glaring clinic gaps using a “learn by doing” approach. More resources are required to scale up these programs and for ‘good practice’ evidence to be gathered.