Number of vulnerable children living with HIV

How to use this indicator

There is elevated risk of HIV among children affected by and vulnerable to HIV. Implementing partners of the United States President's Emergency Plan for AIDS Relief (PEPFAR) track this indicator through the numerator of OVC_HIVSTAT, but they do so solely among project specific beneficiaries, whereas this indicator tracks HIV status of vulnerable children supported by any community-based program. When there is awareness of the HIV status of vulnerable children, programs and governments can ensure that children are linked to appropriate care and treatment and that their households are provided with support, such as psychosocial, health, education, nutrition, legal, and household economic strengthening services. Of the 2.1 million children living with HIV globally, only 43 percent were on antiretroviral therapy (ART) as of 2017, and without treatment, half will die by their second birthday. This indicator is essential to the identification of children living with HIV, because identification allows them to get on treatment as early as possible.

Governmental and implementing organizations should assess HIV risk of supported vulnerable children and can do so through reporting for this indicator. Results should guide provision of HIV counseling and testing services to those most at risk and ensure those who test positive for HIV are enrolled and retained in care.

Numerator

Number of vulnerable children living with HIV

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

Depending on country context, vulnerable children may be defined as follows: a child below the age of 18, who because of circumstances, lacks access to the basic needs and resources in the areas of safety or protection, stability, education, and health that are necessary for optimal growth and development. This category can also include the following subpopulations of children, depending on the population a project targets: children who have lost one or both parents; children with chronically ill parent(s); children of members of key populations; child victims of abuse and exploitation; abandoned children; children living on the street; children born out of wedlock; unaccompanied and separated children; internally displaced and refugee children; children of migrant workers; children of asylum-seekers; children in labor camps; child victims of sexual exploitation; children in armed forces; children in residential care facilities; children in alternative care; or children who engage in illegal behavior, are stigmatized, or under the control of others.

This information is gathered, through self-reporting, when a caregiver is asked whether his or her child has been tested for HIV and the results of that test. Children may be aware of this information, but the community worker should engage with caution because disclosure should be family centered. If the child is reported to be HIV-positive, then the community worker should count the child towards this indicator.

Community workers first register vulnerable children and determine their HIV status, and if their status is unknown, the community workers should conduct an HIV risk assessment. If identified to be at risk, the child is then referred to testing. The community worker can then count this child as HIV-positive if the child was tested and received a positive result.

HIV risk assessments should be administered by community workers, to determine the child’s risk of acquiring HIV, if status is unknown, and those at heightened risk should be referred for HIV testing. This will save resources, reduce costs, and ensure quicker identification of those living with HIV. Community workers should also track the numbers of HIV testing referrals, completed referrals, and children who refuse to self-report following testing, but this information should not be counted towards this indicator.

Data source

This indicator is sourced from risk assessments, registers, client records, referral forms, and case management tools used by community workers to monitor vulnerable children in their communities. This indicator is tracked by vulnerable children (VC) programs in service provision, comprehensive family care, vulnerability assessment, risk assessment, enrollment, and follow-up forms. Community workers gather information on the HIV status of both the children and the adults in the household. In some country contexts, key population and VC programs work in collaboration to ensure HIV-positive members of key populations who are caregivers are linked to VC program support services. Some VC programs have an even larger mandate and provide support to children of key populations who are HIV-negative as well.

Disaggregation

  • Status type
    • Reporting HIV-positive to implementing partner
    • Reporting HIV-negative to implementing partner
    • No HIV status reported to implementing partner
      • Test not indicated
      • Other reasons

While all of the above information is suggested for data collection by community workers engaged in supporting vulnerable children, only reporting HIV-positive to implementing partner should be counted towards this indicator.

Data quality considerations

The overall number reported for this indicator should be equal to the sum of individuals in each disaggregation type. This indicator does not imply that all vulnerable children should be tested for HIV, nor does it suggest a calculation to yield the number of new HIV-positive diagnoses.

HIV risk assessments should not be overly complicated but should be created in line with the average educational level of the community workers completing the assessments. Community workers should not be asked to sum a series of risk factors before they can establish whether a child is eligible for HIV testing referral, because this can lead to confusion. Outcomes for children at risk and children not at risk should be clearly labeled on the form. And next steps with guidance and instructions for referral to HIV testing should always be included. Note that community workers should be allowed to report on self-reported HIV-positive test results, which is necessary for effective case management. Case management tools also should always include HIV-negative test result as a field, and community workers should be trained to not leave this blank but mark this field accurately. Enrollment and case management forms may also include fields for whether HIV-positive children are either currently or not currently on ART, and should do so for PEPFAR-funded programs, but this information should not inform the calculation for this indicator. 

Reporting frequency

Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a semiannual basis.

Data element

HIV status of vulnerable children

Category

Vulnerable Children

Data use case

To see a data use example for this indicator, please click below.

HIV Status of Vulnerable Children in the Democratic Republic of the Congo 

Additional Resources

Listen to the MEASURE Evaluation webinar on OVC_HIVSTAT and linkages to care for strengthened collection, analysis, and use of routine health data here: https://www.measureevaluation.org/resources/webinars/strengthening-the-collection-analysis-and-use-of-ovc_hivstat-data

References

The United States President’s Emergency Plan for AIDS Relief (PEPFAR). (2018). Monitoring, Evaluation, and Reporting (MER 2.0) Indicator Reference Guide Updated Release (Version 2.2). Washington, DC: PEPFAR. Retrieved from https://www.pepfar.gov/documents/organization/263233.pdf

Biemba, G., Walker, M. E., & Simon, J. (2009). Nigeria research situation analysis on orphans and other vulnerable children. Boston, MA, USA: Boston University, Center for Global Health & Development Initiative for Integrated Community Welfare in Nigeria. Retrieved from https://open.bu.edu/handle/2144/26992

Stark, L., Rubenstein, B., Muldoon, K., & Roberts, L. (2014). Guidelines for implementing a national strategy to determine the magnitude and distribution of children outside of family care. Washington DC: USAID Center of Excellence on Children in Adversity. Retrieved from http://www.cpcnetwork.org/wp-content/uploads/2014/05/surveyguidelines_childrenoutsidefamilycare_final.pdf

Cantwell, N., Davidson, J., Elsley, S., Milligan, I., & Quinn, N. (2012). Moving Forward: Implementing the “Guidelines for the Alternative Care of Children.” Glasgow, Scotland: UK Centre for Excellence for Looked After Children in Scotland. Retrieved from https://www.unicef.org/protection/files/Moving_Forward_Implementing_the_Guidelines_English.pdf

Children, HIV and AIDS. (2018). Retrieved from https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/children

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