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Pediatric HIV program evaluation in Africa

In an effort to better understand the strategic value and impact of its largest investment to date, The Children’s Investment Fund Foundation (CIFF), London (UK), requested an evaluation of the work of the Clinton HIV/AIDS Initiative (CHAI). This report is intended to support decisions in CIFF’s future commitments, and equally to aid CHAI in identifying any gaps and challenges in its programming efforts. Reflecting CIFF’s funding to date, research focused on programming covering its grants to the Pediatrics initiatives, with focus on the following programs:
  • Kenya Pediatrics Initiative to support the government’s scale-up of treatment and care
  • Rwanda Pediatrics’ support of the Partners in Health comprehensive rural care program
Led by Dr. Warren Kaplan, programs have been assessed on a qualitative, and where possible a quantitative basis, to verify the level of effectiveness and efficiency of their strategies, as well as identify risks they face in their missions to maximize the number of HIV/AIDS patients in quality care and treatment.

In Rwanda, CHAI has played a central role, alongside UNICEF, in the national scale-up plan for pediatric treatment, as well as diagnostics protocols. It has enabled savings of $4.3 million in the purchase of drugs and reagents while coordinating procurement among other major donors. CHAI’s centerpiece project, support of Partners in Health’s comprehensive rural healthcare strategy, has put 1,800 patients on ART in the last 15 months (about 7% of the national caseload), including 141 children with another 262 eligible but not yet started. Sustainability of the PIH model remains uncertain, but expectations are positive. The Rwandan government strongly supports the program and its core “child survival” tenets.

In Kenya, as compared to Rwanda, CHAI’s approach to pediatrics programming tends to channel small funds to discrete, targeted interventions requested by the government and other partners. The national program and CHAI continue to make good progress in meeting their respective treatment targets. It’s too early to say that all of CHAI’s programming efforts are consistently filling key gaps or creating demonstrable scale for an effective care and treatment system. A yearlong project with the CDC to create access for infant HIV diagnostics, especially in remote areas, has achieved an eight-fold increase in the number of tests produced. CHAI’s low-cost funding of a small rural pediatrics center, resulting in a five-fold increase in ART patients in the first year, is a good example of its investment decision-making process. The question now is how to leverage that experience beyond a one-off demonstration project. Grants for training and mentoring programs have undoubtedly increased access to HIV treatment and care, and some improvement in the quality of care delivery. However, the program has not directly measured impacts on quantity or quality of care and treatment, so impact is largely inferred.

Information from the Third International Conference for Improving Use of Medicines, ICIUM2011