BACKGROUND: In Zambia, children and adolescents remain at risk of HIV infection due to social, cultural, and economic vulnerabilities, but HIV testing, and treatment coverage is lower in this population compared to adults. Community-based testing initiatives, such as index testing of biological children of women living with HIV (WLHIV) and HIV testing for beneficiaries of Orphaned and Vulnerable Children (OVC) programs, have been the key case finding strategies to reach undiagnosed children. We gathered HIV testing lessons learned from 2 years of OVC program implementation in Western Province, Zambia.
DESCRIPTION: Western Province has many hard-to-reach settlements where flood plains and sandy terrain hinder access to health facilities. The U.S. President’s Emergency Plan for AIDS Relief, through the U.S. Centers for Disease Control and Prevention (CDC Zambia) and partners, began implementing OVC services in Western Province in October 2020.
OVC program, in collaboration with local community partners, strengthened access to HIV testing service through home-based community testing. Further, all vulnerable children and adolescents (aged <18 years) (VCA) were paired with case workers residing in the same communities for personalized support. Case workers ensured that OVC enrollees and their families had a documented HIV status and played a key role in active community follow-up and testing of children and adolescents born to WLHIV.
LESSONS LEARNED: Collaboration with local community partners, for home-based HIV testing, eliminated the need to travel through flooded terrain, resulting in an increase in the proportion of VCA with a documented HIV status from 71% (2,456/3,442) in 2021 to 94% (15,761/16,772) in 2022. Enlisting local case workers facilitated better community follow-up of WLHIV, increasing the contribution of OVC districts to family index testing in Western Province from 12% (1,274/10,331) in 2021 to 45% (3,595/8,078) in 2022, identifying 308 children living with HIV out of 4,869 index tests (6% positivity), and linking 91% (281) to treatment.
CONCLUSIONS: OVC programming increased HIV testing access among VCA in hard-to-reach Western Province. CDC Zambia will, therefore, continue scaling up OVC services and explore other cost-effective initiatives to mirror OVC support in non-OVC sites in order to further reduce the pediatric HIV testing gap.

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