WCARO Consultant Formative Multi-country Evaluation of the WCA Family HIV Testing (FHT) Approach, Home-based & Field work in Cote d’Ivoire & Travel to Ghana, 4 months

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1. Background


While countries strive to increase their capacity to decentralize early HIV testing – including through point-of-care diagnostic technology -, it was imperative to better engage family and community members in the treatment and care of children and adolescents living with HIV.

In 2019, UNICEF, in collaboration with WHO and UNAIDS, developed operational guidelines “for scaling up Family HIV Testing (FHT) in West and Central Africa (WCA)” and provided technical assistance to countries to implement the strategy.

The Guidelines have spurred much interest across countries in the region as the «Family-Centered Approach» in HIV programming through Family HIV Testing is expected to achieve two key objectives:

  1. Early identification of children and adolescents living with HIV
  2. Linkage to- and retention of children and adolescents living with HIV and their families, in HIV care services.

Twenty of the twenty-four WCA countries have adopted the strategy and are at different stages of FHT implementation, as reflected in the WCA FHT monitoring tool (Dashboard). Reports from 3 countries (Cabo Verde, Mauritania, and Nigeria) were not received since the first round of reporting in Q1 2020.

There was no specific budget allocated to the implementation of the strategy. Countries have taken advantage of existing and potential resources on pediatric care and treatment to advance FHT implementation. As an example, for those countries that have submitted funding proposals to the Global Fund, the strategy has been incorporated into their requests for 2020-2022 allocation.

Thanks to such new approach paired with the use of appropriate tools, service providers are expected to be enabled to measure to what extent they are contributing to 3 types of CHANGES:

    • Change 1: More Families Are Accepting HIV Testing
    • Change 2: More Children Living with HIV are identified
    • Change 3: More Children Living with HIV are initiated to treatment

It is worth noting that the desired changes could only be achieved if countries implement interventions that remove individual and system level barriers as illustrated below:

  • Individual level barriers include: Fear of inadvertent disclosure/stigma, low parent awareness of FHT benefits, unwillingness of parents due to fear, guilt, blame, Logistical challenges of bringing children/family to the facility (transport cost, time off work);
  • System level barriers include: Inconsistent inquiry & offering of testing, Health workers being overwhelmed with increased testing load, poor linkages to treatment/poor referral systems, HIV testing commodities/ART stock outs.

The indicators of such changes are those highlighted in the WCA FHT framework namely: Family Testing acceptance rate, Family Testing positivity rate/ yield, Family Testing linkage rate and Family Testing treatment initiation rate.

  1. Evaluation Purpose

This multi-country evaluation will have two purposes: accountability and learning.

Accountability: This evaluation will provide both the donors (vertical accountability) and the beneficiaries (horizontal accountability) with solid evidence on the extent to which the Family HIV testing approach in all WCA countries is attaining the results based on the Monitoring framework for Family Testing described in the WCA operational guidance.

With respect to learning, this evaluation is expected not only to inform the programme implementation strategies in the new UNICEF Regional Office Management Plan (ROMP) but also to highlight some feasible and realistic corrective actions that may want to be taken to enhance the effectiveness and impact of the Family Testing approach.

More specifically, this evaluation is expected to generate recommendations that will help UNICEF HIV staff (both at the UNICEF Regional Office and Country Offices in the region) as well as other in-country partners (see Table 1 below) to adapt the implementation of Family HIV Testing approach to countries’ specific context and needs and scale it up across the region, so as to turn it into a game changer to FastTrack pediatric care and treatment.

More specifically, the evaluation is expected to contribute to the formulation of key strategic and operational recommendations that could be used to

  • better support governments to roll out the approach across the region (this is of paramount importance for UNICEF).
  • Work more closely and effectively with all WCA countries, national HIV and AIDS programs and related partners towards the FastTrack of identification and treatment of children/adolescents living with HIV in line, with the 2021 HLM commitments (95–95–95 testing and treatment targets are achieved within all subpopulations, age groups and geographic settings, including children living with HIV by 2025);
  • Contribute to the development of national, regional, and global advocacy on: 1) FHT as an innovative approach to improve care and treatment for children and adolescents living with HIV and; 2) Resource leveraging for the scale up of FHT;
  • Enhance the effectiveness and efficiency of UNICEF Partnership Cooperation Agreements (PCA) at country level in connection to the implementation of the FHT approach.

Several users of this evaluation were identified, each with a specific interest in using the evaluation findings.


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Added 1 day ago - Updated 1 hour ago - Source: unicef.org