Policy Brief: Palliative Care for children with Drug-Resistant Tuberculosis


The International Children's Palliative Care Network (ICPCN) in partnership with the RIATT-ESA Care and Support working group is launching a policy brief for Palliative Care for children with Drug-Resistant Tuberculosis.

Tuberculosis (TB) in children has become a serious health issue worldwide and new estimates reveal that at least 67 million children have been infected by TB with 850 000 developing the active disease. This is compounded by the fact that two million of these children have been infected by multi-drug resistant TB, leading to 25 000 cases requiring expensive and toxic treatment. The need for palliative care for children with DR-TB cannot be overstated.

Some of the recommendations include:

  • The Integration of children’s palliative care into primary, secondary and tertiary healthcare services.
  • Training of all health and allied health workers in children’s palliative care, ensuring that training is provided through basic training and continuing education, intermediate training and specialist palliative care training.
  • Ensuring equitable access to pain-relieving and other palliative medicines, including opioids in formulations suitable for children.
  • Ensure that care is provided in a holistic manner i.e. physical, psychological, social and spiritual.
  • Sensitise the community to the need for children’s palliative care, identifying individuals who may be local CPC champions.

Click here to download the full policy brief

RIATT-ESA Advocacy Brief- Stigma and Discrimination on Adolescents Living with HIV.

In October 2016 RIATT-ESA and partners  developed anadvocacy brief on the need for programming and policy alternatives to address stigma and discrimination among adolescents living with HIV.

Evidence suggests that stigma and discrimination affects access to and uptake of services while constraining the overall well‐being of adolescents living with HIV. Effects of stigma and discrimination include social isolation, propagation of myths, acts of violence and blaming which affects an individual’s self‐worth, hinder correct information and quality of care and other services. Building psychosocial resilience of adolescents living with HIV who may experience stigma and discrimination is critical to insuring the optimal development and wellbeing of adolescents.

Click here to download the Advocacy Brief on Stigma and Discrimination on Adolescents Living with HIV.

Time to Step-up: Prioritize Children, Adolescents, Families and Carers Affected By AIDS in Eastern and Southern Africa: Executive Summary

The Call to Action Outlines Action Steps Needed to Prioritize Children Affected by AIDS in the era of the Sustainable Development Goals

Ending the HIV pandemic is possible, but to do so, we must act quickly and recognize that the needs of children—the most vulnerable among us and unable to advocate on their own behalf—include but go beyond ending the spread of HIV and finding a cure.

Policy Brief: Child cash transfers halve HIV risk behaviours for adolescent girls

Why is this important?

A million youths in sub-Saharan Africa are infected with HIV annually. Girls are at up to three times the risk of boys. Transactional and age-disparate sex (‘sugar daddies’) are a key cause of HIV-infection. Systematic reviews show limited effectiveness of behavioural HIV-prevention programmes. Cash transfers to alleviate poverty may be helpful.

The research:

Longitudinal survey, 3,515 children aged 10–18 (<2.5% refusal, 96.8% retention rate), 2009–12.

Stratified random sampling of entire census enumeration areas in rural and urban sites in two South African provinces (Western Cape andMpumalanga).

Propensity score matching to replicate randomised controlled trial conditions, additional check in multivariate logistic regression


Policy Brief: Household mobility and school drop-out in orphans and vulnerable children

Past studies have found that orphans and other children made vulnerable by HIV (OVC) in sub-Saharan Africa are at increased risk of moving household and of school drop-out. However, the relationship between child migration and school enrolment has not been established. We conducted secondary analysis of prospective data, collected from 2002–2006, to investigate whether children who recently migrated were at increased risk of dropping out of school. We also investigated associations between orphanhood, type of caregiver and school drop-out, and whether any such associations are explained by an increased risk of migration among affected children.

The questions:

•Are children who move household at increased risk of dropping out of school?

• Does moving household mediate the relationship between orphan hood and school drop-out?

The research:

• 2002–2006: Enrolled and followed up 645 children aged 6–18 as part of a cohort study.

• Included orphaned and non-orphaned children.

• Collected data on type of caregiver, school drop-out and migration.

• All analyses control for age, gender, socio-economic status, and community type.


Policy Brief: Substance abuse and education in orphans and vulnerable children

Alcohol and drug use amongst adolescents and young adults in sub-Saharan Africa is a potential problem, particularly among orphans and vulnerable children (OVC), and may be ameliorated by school enrollment, but there are no published findings from Zimbabwe on this. We collected data from 5,297 adolescents and young adults from 2009–2011 to investigate whether orphans and/or children caring for a family member with HIV are at increased risk of alcohol, tobacco and drug use.

The questions:

• Are OVC at an increased risk for smoking and alcohol and drug* use?

• Do OVC who practice substance use have greater HIV risk behavior?

• Does school enrollment reduce substance use in OVC (thereby potentially reducing HIV risk behavior)?

* Believed to be mainly marijuana in this population


Policy Brief: Adult treatment and care services an entry point for children’s well-being

HIV care and treatment services (HIVCTs) have greatly improved survival and reduced morbidity of HIV-infected persons. Also, HIVCTs have been associated with a significant decline in the incidence of orphanhood and children born with HIV infection (April, MD, et al., 2014; Mermin, J, et al., 2008; Makumbi FE, et al., 2012). However, the indirect effects of parental enrolment into HIVCTs on their children’s schooling are unknown. We investigated the association between parental enrolment into HIVCTs and children’s school non-enrolment or drop-out in Rakai district, South-Western Uganda.

The question:

• What is the effect of parental enrollment into HIV care and treatment services on children’s school enrollment and drop-out in a rural resource-limited setting with a universal primary education policy?

The research:

• Secondary data from four annual censuses/surveys in the Rakai Health Sciences Program population-based cohort in 50 communities.

• Inter-survey proportion of children (6-16 years) enrolled in school, drop-out (child in household previously enrolled in school but not currently in school) and adult enrollment into HIVTCs.

• Random effects logistic regression population average models for repeated measures analysis, with unstructured correlation structure used for the analysis.


Policy Brief: Evidence for improving psychosocial outcomes for children affected by HIV/AIDS

Why is this issue important?

•HIV/AIDS places children at risk for poor social, emotional and mental health outcomes.

• There is a great deal of funding dedicated to addressing this issue, but very little evidence about what works to improve psychosocial outcomes for these children.

• In 2009, a systematic review could not identify any study that had adequately evaluated an intervention to improve psychosocial well-being for AIDS-affected children.

• This lack of evidence means that we don’t know how programmes or interventions work to improve child outcomes, if they are reaching the most vulnerable, or even if they are having unintended negative effect


Policy Brief: Pathways from parental AIDS to psychological, educational and HIV risks for children

The questions:

• Evidence shows that parental AIDS-illness and death have severe negative impacts on children. However, we need to understand why AIDS hasthese effects.

• This study aims to identify these pathways, and thus identify important targets for interventions.

• Three key outcomes are examined: psychological, HIV-infection risks and educational.

The research:

• Cross-sectional survey of 6,002 children aged 10–17.

• Rural and urban sites in the Western Cape, Mpumalanga and KwaZulu-Natal, South Africa.

• Validated scales and symptom checklists were used. Structural equation modelling in AMOS 19 identified pathways of risk. AIDS-orphanhood and parental AIDS-illness raise risks of poverty and parental disability. Through these linkages, AIDS-affected children are more likely to be stigmatised outside the home, and exposed to physical, emotional and sexual abuse or rape. It is these ‘interlinking factors’ that cause psychological distress such as depression, anxiety and suicidal behaviour. And it is psychological distress that leads to higher rates of HIV infection risks (such as transactional sex and low condom use) amongst AIDS-affected adolescents.



New RIATT-ESA Call-Time to Step-Up: Prioritise Children, Adolescents, Families and Carers Affected By AIDS in Eastern and Southern Africa

The Call to Action Outlines Action Steps Needed to Prioritize Children Affected by AIDS in the era of the Sustainable Development Goals

Ending the HIV pandemic is possible, but to do so, we must act quickly and recognize that the needs of children—the most vulnerable among us and unable to advocate on their own behalf—include but go beyond ending the spread of HIV and finding a cure. 

For children, urgent steps are required including:

  • Better integrating strategies to reach this population into regional and national plans

  • Providing the care and support needed to ensure optimal development

  • Scaling up treatment, prevention and access to services—for children and their carers

The call to action sets out eight critical action steps needed to provide children, adolescents and carers with the focused attention required to turn the tide on HIV and AIDS:

  • Scale-up access to PMTCT services

  • Scale-up paediatric testing (early infant diagnosis)

  • Increase treatment access and reduce loss to follow-up

  • Provide HIV-sensitive social protection services

  • Invest in the early years of children living affected by HIV

  • Strengthen linkages between child protection and HIV services

  • Intensify HIV prevention and treatment for adolescents

  • Strengthen support for primary caregivers and community level care providers

Comprehensive Care and Support for Orphans, Vulnerable Children & Youth (OVCY) in the Southern African Development Community


Strategic Framework and Programme of Action (2008 – 2015)

Poverty and under development remain daunting challenges for the SADC region. About two thirds of the population in the region live below the international poverty line of US$ per day. Poverty is exacerbated by high levels of diseases, unemployment and low industrial growth and productivity which characterise most of the Member States. Food insecurity is particularly acute in the region, largely due to natural disasters associated with climate change such as floods and recurrent drought. Human productivity has also been curtailed by labour migration and high morbidity and mortality rates among the economically productive age group largely as a result of the treble effect of HIV and AIDS, Malaria and Tuberculosis, among other diseases and causes of death. The recent global increase in energy and food prices and the crisis in the financial markets are exacerbating the already dire situation in the region. Poverty and the high levels of morbidity and mortality among adults have resulted in an in unprecedented upsurge of orphans and other vulnerable children and youth (OVCY) in the region. Health, social and economic forecasts indicate that the situation is likely to remain serious with increasing household poverty and number of orphans in the foreseeable future. Vulnerable and poor households such as those headed by children, women, older people, people living with disabilities and HIV and AIDS and the unemployed bear the brunt of these numerous challenges, with often little or no options to cope.

The Strategic Framework and Programme of Action mark the first deliberate effort to mount a regional response to the growing challenges of OVCY in SADC. The Framework recognises the complexity of the matter and in that regard, has adopted a holistic and integrated approach to ensure comprehensive care and support among OVCY [Taken from foreword].