Views from the Frontline – Experiences of supporting key populations affected by HIV

Dr. Patrick Oyaro specializes in Epidemiology. He is also Chief of Party for USAID Stawisha Pwani. The Coalition for Children Affected by AIDS recently spoke with Dr Oyaro to understand his experiences as a Frontline Health worker supporting people affected by HIV, including children and adolescents.

As part of his commitment, Dr Patrick Oyaro has been a long-time serving director on the Board of Directors, and a strong advocate within the Paediatric-Adolescent Treatment Africa (PATA) network of frontline health providers. Please see PATA’s call to action highlighting the need for greater investments to support a health workforce that is well-trained, where they have access to the tools, resources and confidence to do their work well. Importantly, that health providers delivering services on the frontline are provided safe working conditions and fair remuneration with access to support and development opportunities.

Dr Oyaro’s work spans over 18 years in HIV clinical services provision, technical support and program management and he currently supports HIV, TB and COVID-19 prevention and management. The cohort on treatment is around 65,000 with 3,600 below 15 years of age. Most of the funding received is facility based with little spent on community aspects. The Government is expected to support the community component through community strategy, but this varies per county, with some able to provide stipends of around $20 per month which is very little.

The HIV services are still heavily donor funded with varying levels of county government ownership and the CALHIV are eligible to be supported by the OVC projects collaboratively as some children and adolescents are orphaned and all are considered vulnerable. The OVC projects need to ensure that they (their households) are Healthy, Safe, Schooled and Stable.

On matters of prevention, Dr Oyaro believes that for his team and all those working to eliminate pediatric AIDS by 2030 as per the Global Alliance Goals, that “We must ensure that all the four prongs of PMTCT work. We need to ensure PrEP, FP services uptake and community support is there to ensure coverage and that we can prevent violence against children (VAC) to stop any transmissions and optimize repeat HIV testing amongst others.”

For Dr Oyaro, the past 2 years have been severely impacted due to COVID-19 and other issues such as an erratic supply of commodities that have prevented early infant diagnosis and thus affected the eMTCT/PMTCT agenda negatively.

Doctors on the frontline like Dr Oyaro have seen that the uptake of pediatric DTG has been impressive and we need to ensure that we do not lose it to resistance. Resistance testing is available but the process is long. He says, “There is a need for more involvement of caregivers, ensuring caregiver education and that there is mental health support for the health workers and caregivers.” He also considers facilitation and support for the transition of adolescents into adult clinics as important, along with linking the recipients of HIV care to psycho-social support and nutrition as this all affects viral suppression outcomes. Dr Oyaro continues, “We need to involve the department of education and also ensure children of key populations (KP).”

Dr Oyaro’s comments come at a crucial time as we work towards ending AIDS in children and adolescents.

The Coalition for Children Affected by AIDS (CCABA) has launched a new report that identifies how much funding is going to children and adolescents, where, on what and where the gaps are.  This new analysis provides a vital piece of the puzzle to achieve our goals and provides some clear investment opportunities. In particular, testing and treatment, and support to adolescent girls and young women, orphans and vulnerable children, and children and adolescents from populations that are at increased risk of HIV infection.

To learn more about these important research findings on closing the funding gap for children and adolescents, download the report here.