Abstract

Background
Children and adolescents living with HIV (C/ALHIV) in Zambia are concerningly far away from the UNAIDS goals of 95/95/95 (72.8% of young people living with HIV were diagnosed, 71.7% on ART and 66.6% are virally suppressed)(1). Unfortunately, HIV testing, access to care and retention in care for children is largely dependent on their caregivers(2). Unmet psychosocial and economic needs impact caregivers and subsequently the ability of C/ALHIV to adhere to their treatment plans and be clinically stable(2).
In October 2019, The US Centers for Disease Control and Prevention (CDC) Zambia started supporting the orphans and vulnerable children program (OVC) which resulted in notable improvements in treatment outcomes for C/ALHIV enrolled in OVC compared. The rate of treatment interruption was lower in OVC sites, while viral load coverage (VLC) and viral load suppression (VLS) were higher in these sites. The improved treatment outcomes were largely attributed to the community case management approach, which is the hallmark of the OVC program, adopted to scale up Sungani Bana Initiative.
Methods
In 2022, CDC Zambia utilized the case management strategies from the OVC program to develop the Sungani Bana initiative. This strategy implements child-centered case management in specific non-OVC sites, aiming to minimize barriers for children and adolescents living with HIV (C/ALHIV) and enhance their access to treatment services. Sungani Bana involves identifying community case workers who are trained in case management. The case workers establish a trusting relationship with C/ALHIV and their families. Each case worker provides support to 20 C/ALHIV through monthly home visits, appointment reminders, TB screening, and nutrition assessments.
Results
Between October 2022 and September 2023, interruption in treatment decreased from 3% to 1%, VLC increased from 79% to 84% and VLS increased from 93% to 95% in the non OVC supported areas where Sungani Bana was implemented.
Conclusions
Community case management through the Sungani Bana initiative has yielded positive results in improving treatment outcomes, like the successes observed in the OVC program. CDC Zambia will continue to scale up the model to all non- OVC sites to ensure improved treatment outcomes among all C/ALHIV.

1. ZAMPHIA. ZAMPHIA Zambia Population-based HIV Impact Assessment (ZAMPHIA 2021) Zambia Population-based HIV Impact Assessment (ZAMPHIA) 2021. 2021;(December). Available from: https://nada.zamstats.gov.zm
2. Information B, Info B. Better Information for Health in Zambia ( Better Info ) Study A Toolkit for a Sampling-Based Approach to Understand HIV Treatment Outcomes.