Orphans And Vulnerable Children Research Articles

Incentive based continuum of care for people living with HIV including orphan vulnerable children- the Delhi Model

Background: Delhi State AIDS Control Society (DSACS) addressed critical integration of services for Orphan and Vulnerable Children (OVC) in context of HIV. They bridged the policy and implementation divide by formulating a multisectoral-strategy in April 2012, creating a model of "Continuum-of-Care for People-Living with HIV (PLHIV), OVC & Children-Affected-by-HIV (ChABH)” in Delhi. With input from the National Commission for Protection of Child Rights, DSACS sensitized political and administrative machinery about needs and challenges related to HIV/AIDS. DSACS developed an incentive-based system for Antiretroviral Therapy (ART) adherence, incorporating safeguards and robust monitoring. Delhi Government's sustained financial commitment and DSACS programmatic-innovation provide a scalable blueprint for India and global initiatives. Description: This ongoing Delhi Government's scheme focuses on household-economic-strengthening of PLHIV as an incentive for broader behaviour change based-on specific eligibility conditions. Beneficiaries fall into four categories: PLHIV, including children on ART; double orphan HIV positive children (OCI); destitute children living with HIV/in institutional care (DCI); and double orphan ChABH in community-based care in Delhi. Category-wise fixed-monthly financial assistance is released to beneficiaries via direct-bank-transfers leveraging Aadhaar-platform to eliminate corruption. Adherence to treatment is mandatory to continue cash-transfers. Linkages with other schemes established to maximize impact. Lessons learned: In its 11-year evolution, Delhi model has grown from 1110 to 6467 beneficiaries, including 6383 PLHIV, 34 double OCI, 50 DCI, and 27 double orphan ChABH, with 5875 (90.8%) currently active excluding beneficiaries who expired (n=328), migrated/ transferred out of Delhi (n=115), opted-out ART/or lost-to-follow-up (n=135), and 14 CABA who turned major. Steady progress and 98% ART adherence mark positive outcomes. DSACS eased eligibility criteria in 2018, facilitating hurdle-free enrollment, while responding to cost-inflation by enhancing financial assistance, showcasing program adaptability. Achieving >95% ART adherence has significantly boosted survival rates, underscoring program's positive impact on beneficiary health. The scheme's INR 14,69,35,600 expenditure in 2022-23, just 0.13% of Delhi Health Department's plan-outlay, signals a cost-effective investment. Extrapolating this nationally would represent 1.5% of India's Health Ministry's current plan-outlay. Conclusion/next steps: This innovative model is implementable on large-scale in India and around the globe but requires not only financial commitment but also coordinated efforts, policy adjustments, and collaboration between various stakeholders.

Echoes of Ubuntu Capacity in The Realization of Child Rights Through Ujamaa Intersections – A Case of a Parasocial Work Model in Tanzania

Child rights abuse has become a serious global concern in the 21st century as it has been reflected in the global agenda of SDGs. Tanzania like other developing countries experienced significant child rights abuse in the 1990s due to the influx of the number of orphans and vulnerable children (OVC) which was highly influenced by the HIV and AIDS pandemic, poverty, urbanization, etc. OVC was exposed to the high risk of being deprived of their rights following the failure of the formal systems and the shortage of childcare workforce that necessitated the government to involve the key child welfare stakeholders to revitalize and capacitate among the Ujamaa Intersections Models (UIM) under Ubuntu philosophy. Ultimate the country successfully designed an Indigenous cadre of para-social work (PSW) that advocated for and addressed the multiple rights of vulnerable children from 2007. Initiation and operation of PSW are embedded in the Ujamaa sections from side to side with social work and Ubuntu competence, this combination capacitated existing Ujamaa Intersections in the community such as family, extended families, neighborhood, local leadership, ecology, spirituality, and wider attributes in realizing child rights. The relevance of Ubuntu values and social work enabled para-social workers to identify the special needs of vulnerable children, increase community child protection awareness, create alarm systems for abused children, and sometimes link them to temporary self-shelters or social welfare services, etc. Despite the challenges, PSW succeeded in advocating for children's rights and improved the quality of life of children and their families. PSW has rendered evidence based on how the Indigenous models can offer relevant and sustainable solutions in addressing the rights of vulnerable populations in the community. Over time, several African countries adopted the PSW model and the model calls for child rights stakeholders and global decision-makers to revisit and relearn the capacity of the PSW model in the realization of SDG including protecting children from abuse, exploitation, trafficking, and violence. Also, it has relevant sustainable opportunities that ensure children attain inclusive and equitable quality social welfare services.

Assessing the effect of COVida orphans and vulnerable children support services on viral load coverage and suppression among children and adolescents living with HIV in four provinces in Mozambique

ABSTRACT Orphans and vulnerable children (OVC) programs focusing on improving HIV outcomes for children and adolescents living with HIV (C&ALHIV) may improve viral load (VL) testing coverage, a critical step toward achieving VL suppression. In Mozambique, we conducted a retrospective medical record review comparing VL testing coverage and suppression between C&ALHIV receiving OVC support and two cohorts of non-participants constructed using propensity score matching. We collected data for 25,783 C&ALHIV in Inhambane, Maputo City, Nampula, and Tete between October 2020-September 2021. Unadjusted rates of VL testing were 62.9% among OVC participants compared with 39.2% and 50.4% of non-participants in OVC support and non-OVC support districts, respectively. In multivariate models, OVC participants were 18 and 10 percentage points more likely to have received a VL test than non-participants in OVC districts (p < 0.01) and non-OVC districts (p < 0.01), respectively. OVC participants under 5 years old were significantly more likely to have received a VL test than their same-age counterparts in both comparison groups. Overall, the OVC program did not demonstrate significant effects on VL suppression. This approach could be replicated in other contexts to improve testing coverage. It is crucial that clinical partners and governments continue to share data to enable timely monitoring through OVC programming.

Perception of Foster Care As An Alternative To Institutionalization of Orphans And Vulnerable Children (OVC) By Residents of Oredo Local Government Area, Edo State of Nigeria

Perception of Foster Care As An Alternative To Institutionalization of Orphans And Vulnerable Children (OVC) By Residents of Oredo Local Government Area, Edo State of Nigeria

Stakeholder Participation in Needs Assessment and Sustainability of Orphans and Vulnerable Children (OVC) Projects in Mount Elgon Sub-County, Kenya

Most projects are customized in project management. Hence, successful accomplishment of the projects requires stakeholder participation. Moreover, the management of stakeholder’s participation in OVC projects is1 receiving more concentration in practice. The objective of the study was to establish the influence of stakeholder participation on sustainability of OVC projects in Mount Elgon Sub-County, Kenya. We sought to establish the influence of stakeholder participation in needs assessment on sustainability of OVC projects in Mount Elgon Sub-County, Kenya. The two grounding theories were; Freeman’s stakeholder theory and resource-based theory. The study employed a descriptive survey research design with a target population of 176 and a sample size of 122 stakeholders. The study applied quantitative methods of data collection. The questionnaires were pre-coded to ease data entry. Quantitative data was analyzed using SPSS to obtain frequency distributions, percentages, mean and standard deviations. The study findings delineates that stakeholder participation in needs assessment is significant in influencing sustainability of OVC projects with correlation coefficients of (r=0.623; P&lt;0.000). The study concluded that stakeholder participation in need assessment significantly influences sustainability of OVC projects. The study subsequently recommended that stakeholder participation in needs assessment should be comprehensively undertaken during implementation of OVC projects in order to enhance their sustainability.

Multivariate mixed-effects ordinal logistic regression models with difference-in-differences estimator of the impact of WORTH Yetu on household hunger and socioeconomic status among OVC caregivers in Tanzania.

Although most of the livelihood programmes target women, those that involve women and men have been evaluated as though men and women were a single homogenous population, with a mere inclusion of gender as an explanatory variable. This study evaluated the impact of WORTH Yetu (an economic empowerment intervention to improve livelihood outcomes) on household hunger, and household socioeconomic status (SES) among caregivers (both women and men) of orphaned and vulnerable children (OVC) in Tanzania. The study hypothesized that women and men respond to livelihood interventions differently, hence a need for gender-disaggregated impact evaluation of such interventions. This is a secondary analysis of longitudinal data, involving caregivers' baseline (2016-2019) and follow-up (2019-2020) data from the USAID Kizazi Kipya project in 25 regions of Tanzania. Two dependent variables (ie, outcomes) were assessed; household hunger which was measured using the Household Hunger Scale (HHS), and Socioeconomic Status (SES) using the Principal Component Analysis (PCA). WORTH Yetu, a livelihood intervention implemented by the USAID Kizazi Kipya project was the main independent variable whose impact on the two outcomes was evaluated using multivariate analysis with a multilevel mixed-effects, ordinal logistic regression model with difference-in-differences (DiD) estimator for impact estimation. The analysis was based on 497,293 observations from 249,655 caregivers of OVC at baseline, and 247,638 of them at the follow-up survey. In both surveys, 70% were women and 30% were men. Their mean age was 49.3 (±14.5) years at baseline and 52.7 (±14.8) years at the follow-up survey. Caregivers' membership in WORTH Yetu was 10.1% at the follow-up. After adjusting for important confounders there was a significant decline in the severity of household hunger by 46.4% among WORTH Yetu members at the follow-up compared to the situation at the baseline (adjusted Odds Ratio (aOR) = 0.536, 95% Confidence Interval (CI) [0.521, 0.553]). The decline was 45.7% among women (aOR = 0.543 [0.524, 0.563]) and 47.5% among men (aOR = 0.525 [0.497, 0.556]). Regarding SES, WORTH Yetu members were 15.9% more likely to be in higher wealth quintiles at the follow-up compared to the situation at the baseline (aOR = 1.159 [1.128, 1.190]). This impact was 20.8% among women (aOR = 1.208 [1.170, 1.247]) and 4.6% among men (aOR = 1.046 [0.995, 1.101]). WORTH Yetu was associated with a significant reduction in household hunger, and a significant increase in household SES among OVC caregivers in Tanzania within an average follow-up period of 1.6 years. The estimated impacts differed significantly by gender, suggesting that women and men responded to the WORTH Yetu intervention differently. This implied that the design, delivery, and evaluation of such programmes should happen in a gender responsive manner, recognising that women and men are not the same with respect to the programmes.

Managing the Needs of Orphans and Vulnerable Children in Mainstream Rural Schools: An Ethnopsychology Informed Approach

Orphans and vulnerable children (OVC) in mainstream rural schools encounter unique challenges stemming from loss, economic instability, and disrupted familial structures. Addressing their needs demands a comprehensive and culturally sensitive approach. This paper thus explored the use of an ethnopsychology framework to understand and address the diverse needs of rural children, emphasizing the importance of culturally sensitive interventions in mainstream schools. It also evaluated the effectiveness of ethnopsychological interventions and the role of community collaboration. This article used secondary data sources to understand how the ethnopsychology approach can be utilized as a potential sustainable intervention strategy for the needs of OVC in mainstream rural schools. The results show that OVC are well-served by the cultural resources that rural schools have in abundance from a cultural perspective. The study also emphasized the significance of cultural practices and beliefs in influencing community responses and developing resilience in assisting OVC. The study supported the care, protection, and psychosocial support to OVC as significantly influenced by family and relationship networks, community-based organizations, and traditional support systems. The paper made recommendations for improving rural schools’ response to OVC needs in light of cultural sensitivity. These include boosting collaboration between formal and informal support systems, creating community networks, fostering cultural adaptation and preservation, and giving community members more agency through programs that increase their knowledge and skills. This study underscored the significance of ethnopsychology principles of community and social connection in leveraging cultural resources, context-based and responsive interventions, and appreciating and sustaining existing indigenous knowledge systems in understanding and addressing the needs of OVC in mainstream rural schools. Understanding and supporting OVC contributes towards cultivating meaningful collaborations and transformative care of OVC in the Global South. Keywords: Ethnopsychology, Cultural Sensitivity, Rural Community, Mainstream Rural Schools, Orphans and Vulnerable Children.

Acquisition of Economic and Soft Skills among OVC in Southwestern Nigeria

The achievement of the goal of primary education in Nigeria, which targets giving every child the opportunities to develop life manipulative skills, has been a challenge among primary school leavers, most especially the Orphan and Vulnerable Children (OVC). In most cases, the limited resource accessible to the homes has not allow giving the OVC educational opportunity to secondary level. Despite the introduction of some pre-vocational subjects such as Home Economics and Agriculture into the primary school, there is no empirical or physical evidence to show that the pupils are equipped with much life manipulatives skills such as economic and soft skills. This study adopted descriptive survey to investigate the acquisition of economic and soft skills among OVC in some selected southwestern states of Nigeria. The study reveals that the economic skills of the OVC pupils were fairly developed (mean = 1.52). The economic sub-skills of endurance (Mean = 1.57) and self-dependence (mean = 1.51) were the most and least developed respectively. The soft skills of the OVC pupils were fairly developed (mean = 1.76) among other findings. Appropriate recommendations were proffered to enhance the development of economic and soft skills among the OVC in southwestern Nigeria.

Enabling resilience and OVC inclusion through relational agency: a case of OVC inclusion/exclusion into education in Eswatini

ABSTRACT This article looks into enabling the resilience and inclusion of orphaned and vulnerable children (OVC) into education through the social relational networks which they have with others in their environments. Situated within a qualitative approach, the research collected data on the experiences of OVC through semi-structured interviews, questionnaires and a message-in-a-bottle technique. It presents some of the findings on the significant hardships as well as supportive relationships experienced by OVC at the hands of their families, communities and schools. These experiences are framed within a discussion of various understandings of agency and resilience. Favouring a relational approach to agency and resilience, the analyses suggest that, while OVC endure grievous challenges which place them at risk of experiencing exclusion, through the relational networks they have with others, they are able to be resilient and experience inclusion in education and generally.

Navigating Challenges: The Difficulties Faced by Rural NGOs in Empowering Orphaned Children in Zimbabwe

Non-governmental organizations (NGOs) have emerged as pivotal actors in social welfare delivery across developing countries owing to state capacity gaps. However, NGOs often struggle to achieve the intended benefits and long-term impacts, especially in rural community settings. This study aimed to investigate the organizational and environmental challenges experienced by NGOs in implementing programs for orphaned and vulnerable children (OVCs) in Zimbabwe. It focused on an NGO serving over 3,500 OVCs through educational, health, and psychosocial support initiatives in Masvingo province since 2003. Despite its benevolent goals, its efforts were hampered by myriad constraints. A qualitative case study approach was employed, involving interviews with five key personnel, two focus groups with field volunteers and area supervisors, a survey of 28 beneficiaries, and document review. The results showed that there were severe shortages of professionally trained staff who could work in rural areas, severe funding limitations due to limited church grants, unreliable data on target OVCs that made planning and monitoring more difficult, random government hostility through suspensions and too much red tape, and a strong dependence on beneficiaries. While aligning with scholarly critiques of NGO limitations, findings also highlighted the NGO's enduring relevance from proximity to the grassroots. To enhance organizational effectiveness, priorities include capacity building, donor diversification, low-cost monitoring technologies, coordinated government engagement, and fostering beneficiary self-reliance. This empirical inquiry provides original insights to advance the public goods theory on factors undermining NGOs' effectiveness in filling welfare gaps despite trust advantages. The results can inform strategies adopted by practitioners to surmount barriers and achieve public service missions

Impact of Cash Transfers on Household Food Security: Evidence from Families with Orphans and Vulnerable Children in Kenya

ABSTRACT In response to the devastation of the 1990s and early 2000s AIDS pandemic in Sub-Saharan Africa, Kenya introduced the Cash Transfers for Orphans and Vulnerable Children (CT-OVC) program. The program aimed to encourage the fostering and retaining of Orphans and Vulnerable Children (OVCs) within communities and enhance their human capital development. This study uses cluster-randomized longitudinal trial data to examine the program’s household food security impact, using three measures of the accessibility dimension of food security: per adult equivalent food consumption, household food group shares, and the household dietary diversity score (HDDS). After performing difference-in-differences analysis, we find that the transfers had a positive and highly significant impact on HDDS but a statistically insignificant impact on per adult equivalent food consumption. The results are robust to alternative propensity-score-matched specifications. We further observe hidden food source substitution as transfers provided households with greater freedom of food choices from their own purchases and less reliance on food gifts or aid, thereby improving dietary diversity while aggregate food consumption remained largely unchanged. Our findings provide fresh insights to relevant stakeholders such as government agencies, Non-Governmental Organizations (NGOs) involved with social action, particularly for OVCs, and food security researchers.

NGOs’ responses to the challenges faced by orphans and vulnerable children (OVC) in Chegutu, Zimbabwe

AbstractThe present study investigates the role of non‐governmental organisations (NGOs) in addressing the multifaceted challenges encountered by orphans and vulnerable children (OVC) in the rural Chegutu District of Zimbabwe. Employing a qualitative paradigm, a case study design was utilized to collect data through in‐depth interviews. Thematic analysis was used to present the study's findings. NGO selection and participant sampling were purposive in nature. The challenges faced by OVC in Chegutu District encompass various dimensions, prominently, including increased school dropout rates due to poverty. Those who continue attending school encounter shortages of essential items such as uniforms and stationery. Additionally, inadequate clothing poses a challenge for OVC. Broader climate change–related calamities have further aggravated food scarcity in households housing OVC. NGOs have responded to these challenges by providing OVC with school fees, stationery, accommodation and uniforms to address educational needs and enhance prospects. Climate change impacts have necessitated the drilling of boreholes to facilitate nutritional gardens, thereby mitigating food insecurity and income constraints. NGOs have also empowered OVC households through community saving initiatives like internal savings and lending schemes, fostering income generation, and addressing education‐, food‐ and clothing‐related challenges. Furthermore, psycho‐social support groups have been established by NGOs to address the psychological and social issues faced by OVC. Drawing on the basic needs approach, the study reveals that NGOs significantly contribute to fulfilling the basic needs of OVC. However, some gaps in their approaches were identified, highlighting the potential for further improvement and refinement.

Morbidity profile and physical health status of orphans and vulnerable children in selected orphanages in Ibadan, Nigeria

Background: Orphans and vulnerable children (OVC) are prone to poor health outcomes when compared to other children in society. Aims: This study assessed the morbidity profile and physical health status of OVC in orphanages. Methods: A descriptive cross-sectional design was employed and multistage sampling technique was used to select 384 OVC from the orphanages. A structured questionnaire was used to collect data on morbidity profile while a head-to-toe assessment checklist and the body mass index (BMI) were used to assess their physical health status. Analysis was done using descriptive and inferential statistics at a significant level of 0.05. Results: Results showed that the most prevalent health problems experienced by OVC were headaches, respiratory infections, and malaria. The study further revealed that 44.8%, 29.9% and 25.3% of respondents had respectively fair, poor and good physical health. Conclusions: A substantial proportion of OVC have a fair and poor physical health status and the majority are underweight.

Impact of the Mediational Intervention for Sensitizing Caregivers on Mentalizing in Orphans and Vulnerable Children in South Africa

ABSTRACT Mediational Intervention for Sensitizing Caregivers (MISC) is a mentalization-based intervention which aims to enhance caregiver sensitivity and responsiveness. MISC has demonstrated treatment effects on mental health problems of Orphans and Vulnerable Children (OVC) in South Africa by working with Community-Based Organization (CBO) care workers as the point of intervention. Recent elaboration of mentalization-based theory points to alternate figures in a child’s early environment as critical resources for enhancing children’s mentalizing capacity. In this study, we evaluated the treatment effect of MISC on children’s mentalizing capacity at baseline and following 12-months of the intervention, controlling for the effects of age, gender, orphan status, socioeconomic status, quality of the home environment, and mental health difficulties at baseline. MISC and Treatment as Usual (TAU) groups were compared using a mixed model linear regression. Results demonstrated significant effects of MISC, time, and mental health difficulties on mentalizing capacity. To our knowledge, this study is the first mentalization-based caregiver intervention to demonstrate treatment effects on child mentalizing capacity, and MISC is the first mentalization-based caregiver intervention to focus on paraprofessionals as the point of intervention.

The role of orphans and vulnerable children programme in addressing household food insecurity in Botswana

Among the total population, orphans and vulnerable children are more susceptible to food insecurity than their counterparts. To address this challenge, the government of Botswana introduced the Orphans and Vulnerable Children (OVC)’s Programme. This article discusses the role of the OVC Programme in addressing food insecurity within their households in Botswana. It emphasizes that OVC programme has an important role in addressing food insecurity among OVC households. Challenges that hinder ensuring food security among OVC households are discussed. The article offers recommendations on how challenges of the OVC programme can be addressed such as the need to re-structure government and administrative systems for effective and efficient service delivery. The suggested recommendations can be utilized by policymakers when reviewing the OVC programme guidelines. How to reference using ASWNet style:Lefadola, B. P. &amp; Ntshwarang, P. N. (2023). The role of orphans and vulnerable children programme in addressing household food insecurity in Botswana. African Journal of Social Work, 13(4), 188-196. https://dx.doi.org/10.4314/ajsw.v13i4.2 Visit journal website: https://ajsw.africasocialwork.net

Healthcare Service Needs of Orphans and Vulnerable Children in Orphanages and Barriers Caregivers face in meeting their Healthcare Service Needs: A Mixed Method Research

ABSTRACT Poor health and well-being among orphans and vulnerable children (OVC) in orphanages has been documented in literature, and evidence has shown an association between access to healthcare and well-being among this population. This study assessed the healthcare service needs of OVC and explored the barriers their caregivers face in meeting their healthcare service needs using a mixed method research approach. The study utilized a multi-stage sampling technique in selecting 384 OVC and 14 caregivers that participated in the study. Data were collected using pre-tested questionnaire and interview guide. The quantitative data were analyzed using Statistical Product and Service Solutions (SPSS) version 23, while the qualitative data were analyzed using thematic and content analysis. The result of the study shows that regular health assessment while in the orphanage tops the list of health services needed by OVC; this was followed by health assessment before or during admission into orphanages and facility visits for management of common illness by health professionals while health education for the children and caregivers ranked third. Mental healthcare was the least need reported by the children. From the caregivers’ perspectives, financial, structural and psychological barriers emerged as major themes for barriers faced in meeting the healthcare service needs of OVC. The study concluded that OVC are mainly in need of regular health assessment and treatment of common ailments during facility visits by health professionals. The study further shows that caregivers face significant barriers in meeting the healthcare service needs of OVC.

Effectiveness of the Presidential Secondary School Bursary (PSSB) on Education of Orphans and Vulnerable Children in Selected Sub-Counties in Nairobi City County, Kenya

The Presidential Secondary School Bursary (PSSB) was initiated as a complementary service to support Orphans and Vulnerable Children (OVC) in Secondary education in Kenya. However, there is limited evidence on the impact of the scheme on the enrolment, retention, and transition of OVC into higher and tertiary level education. This study examined the contribution of PSSB to the education of OVCs in Nairobi. The study anchored on the Theory of Socialist Economics of Education and Human Capital Theory. The study deployed a qualitative research design. Using purposive sampling, Nairobi County and Kasarani, Westlands, and Langata Sub-Counties were selected respectively. In each Sub-County, student beneficiaries, Principals, and Children’s Officers were the respondents. The sample size consisted of 7 students, 5 Principals, and 6 Children’s Officers selected using a purposive sampling method. In-depth interviews were conducted and data analysed using content and thematic analysis. The results show that the profile of student beneficiaries fit with the selection criteria of OVC benefitting from the scheme and that the PSSB was not adequate as most beneficiary absenteeism from schools was due to fee balances. Deserving students were left out due to non-observance of scheme procedures and guidelines. In terms of its impact, the beneficiaries’ psycho-social wellbeing was good leading to improvement in academic performance. The retention of students also improved. The study recommends an increase in the annual allocation of funds to the PSSB.

Nurses’ Involvement in the Care of Orphans and Vulnerable Children in a Southwestern City in Nigeria: A Qualitative Study from Nurses and Caregivers’ Perspectives

ABSTRACT This study explored nurses’ involvement in the care of Orphans and Vulnerable Children (OVC) in orphanages using the exploratory qualitative method. Data were collected from fifteen nurses and fourteen caregivers of OVC using in-depth interviews. Nurses’ involvement was operationalized as nurses’ current and nurses’ expected roles in providing health care services for OVC. Health promotion and disease prevention, diagnosis and management of common illnesses and advocacy emerged as themes for nurses’ current roles, while health promotion and disease prevention, provision of basic health care services, advocacy, referrals for specialized care & services, and counseling services emerged as nurses’ expected roles. This study showed that curative health care services were the major focus of nurses’ involvement in the care of OVC and these care were provided mainly in the hospital. The study concludes that health care services provision for OVC by nurses should not be hospital-based only. It should be extended to the orphanages where these OVC live through regular visits by nurses to the orphanages. This visitation to the orphanages will give room for early detection and prevention of illnesses before they aggravate.

Factors associated with viral load suppression among orphans and vulnerable children and adolescents living with HIV in Kenya.

While tremendous progress has been made on attaining HIV treatment goals (95-95-95), children's viral load suppression remains a challenge particularly among the orphans and vulnerable groups. In Sub Saharan Africa, there is limited evidence of specific interventions in orphans and vulnerable children (OVC) programs to support children and adolescents living with HIV (CALHIV) to attain durable viral load suppression. Through a large OVC cohort, the study sought to identify correlates of optimal viral load suppression among CALHIV in the Kenya OVC program. This cross-sectional study utilized data on CALHIV below the age of 18 years who were enrolled in the OVC program and actively receiving HIV care and treatment services from ART clinics across Kenya and with documented VL results between October 2019 and September 2020. To obtain a nationally representative sample, data was retrieved from USAID implementing partners' databases across the country. Association between selected variables and VL suppression (outcome of interest) were assessed using a multivariate mixed effect logistic regression model, using glmer function in the LME4 package in R. Factors associated with VL suppression included child's education status (aOR = 1.33; 95% CI: 1.07, 1.65), membership of a psychosocial support group (aOR = 1.258; 95% CI: 1.15, 1.38), and membership of a voluntary savings and lending association (VSLA) (aOR = 1.226; 95% CI: 1.129, 1.33). In addition, child's sex (aOR = 0.88; 95% CI: 0.83, 0.94), caregiver sex (aOR = 0.909; 95% CI: 0.839, 0.997) and "high" status for caregiver household vulnerability (aOR = 0.81; 95% CI: 0.71, 0.924), had an inverse relationship with VL suppression. CALHIV characteristics including child's sex, child's education status (whether currently active in school or inactive) and child's membership in a psychosocial support group were key determinants of VL suppression. Similarly, caregiver sex and membership in a voluntary savings and lending association also influence VL suppression.

Determinants of viral load suppression among orphaned and vulnerable children living with HIV on ART in Tanzania.

In Tanzania, only 66% children 0-14 years living with HIV know their HIV status, 66% are on treatment while 47% of children on ART are virally suppressed. Although retention on ART and poor adherence remain a challenge for children living with HIV, orphans and vulnerable children (OVC) face a greater limitation of access to and utilization of comprehensive HIV care and treatment. In response to this, the current study assessed the determinants of viral load suppression (VLS) among OVC aged 0-14 years living with HIV enrolled in HIV interventions. This was a cross-sectional study that used secondary data collected by the USAID Kizazi Kipya project in 81 district councils of Tanzania. Included in this study are 1,980 orphans and vulnerable children living with HIV (OVCLHIV) (0-14 years) enrolled and served by the project for 24 months. Data analysis involved multivariable logistic regression, with viral load suppression as the outcome of interest and HIV interventions as the main independent variables. The overall VLS rate among the OVCLHIV was 85.3%. This rate increased from 85.3, 89.9, 97.6 to 98.8% after 6, 12, 18, and 24 months of retention on ART, respectively. Similar rates were observed as the duration of adherence to ART increased. In the multivariable analysis, OVCLHIV attending people living with HIV (PLHIV) support groups were 411 times more likely to be virally suppressed than those not attending (aOR = 411.25, 95% CI 168.2-1,005.4). OVCLHIV with health insurance were 6 times more likely to achieve viral suppression than those without (aOR = 6.05, 95% CI 3.28-11.15). OVCLHIV with >95% adherence to ART were 149 times more likely to be virally suppressed than those not adherent to ART (aOR = 148.96, 95% CI 42.6-520.6, p < 0.001). Other significant factors included food security and family size. OVCLHIV reached by the different HIV community-based interventions were more likely to be virally suppressed than those who were not. To advance viral suppression, efforts should be made to ensure that all OVCLHIV are reached by community-based interventions as well as integrating food support in HIV treatment interventions.