Saving Lives for a Lifetime

Abstract

President's Emergency Plan for AIDS Relief (PEPFAR's) response to the millions of children impacted by HIV/AIDS was to designate 10% of its budget to securing their futures, making it the leading supporter of programs reaching orphan and vulnerable children (OVC) programs globally. This article describes the evolution of PEPFAR's OVC response based on programmatic lessons learned and an evergrowing understanding of the impacts of HIV/AIDS. In launching this international emergency effort and transitioning it toward sustainable local systems, PEPFAR helped establish both the technical content and the central importance of care and support for OVC as a necessary complement to biomedical efforts to end the HIV/AIDS epidemic. Critical services are reaching millions of HIV-affected children and families through vast networks of community-based responders and strengthened national systems of care. But rapid program scale-up has at times resulted in inconsistent responses, failure to match resources to properly assessed needs, and a dearth of rigorous program evaluations. Key investments should continue to be directed toward more sustainable and effective responses. These include greater attention to children's most significant developmental stages, a focus on building the resilience of families and communities, a proper balance of government and civil society investments, and more rigorous evaluation and research to ensure evidence-based programming. Even as HIV prevalence declines and medical treatment improves and expands, the impacts of HIV/AIDS on children, families, communities, economies, and societies will continue to accumulate for generations. Protecting the full potential of children-and thus of societies-requires sustained and strategic global investments aligned with experience and science.

Effect of a Family Intervention on Psychological Outcomes of Children Affected by Parental HIV

“…Sherr [37] argues that challenges faced by children at different ages and developmental stages call for age-specific psychosocial interventions. Interventions focusing on younger children have the potential to have long-term impact, while adolescents may need interventions that focus on communication and vocational skills to support their transition into adulthood [38]. This finding can further inform intervention programs to be age- and developmental stage–specific in order to achieve more benefits.…”

Training and capacity development: the foundation of interventions to support young children affected by HIV and AIDS in sub-Saharan Africa

“…Ten percent of the PEPFAR budget was allocated to programs for children affected by HIV and AIDS. In less than 10 years, $2 billion have been disbursed and, in 2010, PEPFAR recorded that 4.1 million children in 30 countries received direct services (Nyberg et al, 2012). In what has been called the emergency phase or Track One, PEPFAR identified seven fundamental domains of services to protect and promote child well-being: education, health, shelter and care, food and nutrition, psychosocial support, protection from abuse and neglect, and economic strengthening (Yates, O’Connell, Davies, & Oladosu, 2008).…”

“…Countless volunteers, community and faith organizations, and government employees received training, as did national and international managers and directors of programs. Building capacity is also seen to be essential to accomplish the second phase of PEPFAR, which is to ensure a locally owned and sustainable response (Nyberg et al, 2012). Training and capacity development are pervasive in OVC programs; for example, training community and government agencies in child rights, training caregivers in parenting and income generating activities, training teachers in psychosocial support, and training young people in vocational skills (Yates et al, 2008).…”

“…Besides identifying reliance on training for the success of programs (Yates et al, 2008), lack of certification of training, meager stipends, unrealistic expectations leading to burnout and high turnover (Nyberg et al, 2012), as well as low coverage by volunteers and others (Bryant et al, 2012), we have not been able to find any published evaluation of the adequacy and effectiveness of training and capacity building as the fundamental basis of programs to support children affected by HIV and AIDS.…”

Does investment in home visitors lead to better psychological health for HIV-affected families? Results from a quasi-experimental evaluation in South Africa

“…Similarly, prior studies have highlighted the potential importance of home visitor compensation, training, and organizational support on beneficiary outcomes (Nyangara et al, 2009; Sherr & Zoll, 2011). In response, donors have prioritized efforts to strengthen the social service workforce, including support for training and regular compensation to home visitors (Nyberg et al, 2012). However, little is known about the results of these resource investments.…”