Clinic-Community Collaboration Toolkit: Working Together to Improve PMTCT and Paediatric HIV Treatment, Care and Support [and Be Connected E-Learning Course]

It is recognised that reaching the "third 90" of the 90-90-90 goals - that is, 90% of people on antiretroviral treatment (ART) with sustained virologic suppression - will require an expanded public health approach, with greater decentralisation of treatment systems and radical new approaches to providing care in the community. In that light, Paediatric-Adolescent Treatment Africa (PATA) and Positive Action for Children Fund (PACF) have worked across 9 countries (Cameroon, Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Malawi, Nigeria, Uganda, Zambia, and Zimbabwe) through their partnership on the 3-year C³ programme on collaboration between clinics and community-based organisations (CBOs) to deliver services together for improved prevention of mother-to-child transmission (PMTCT)-paediatric case finding and HIV treatment. This toolkit aims to scale these results by providing a step-by-step guide to assist health providers, community-based staff, and local coordinators to initiate, expand and improve upon joint activities and action plans based on the 3-year C³ experience. It is accompanied by Be Connected, an e-learning course informed by the C³ programme's successes and lessons learnt.

PATA and PACF note that half of children living with HIV do not receive antiretroviral therapy (ART). Without timely treatment, one third of children with HIV will die by the age of one, and half by two. To reach and sustain pregnant women and children and adolescents in care, clinics and the communities they serve must act together to increase uptake, link children and families into care, combat stigma and discrimination, monitor programme quality, and build stronger local health systems. Clinic-community partnership was recognised in the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping their Mothers Alive, which advocated for enabled and empowered communities.

The toolkit offers a systematic approach and series of methodologies on how clinic-CBO partnerships can be built through shared projects, with the goal of expanding access to prevention, treatment, and care for pregnant women and children and adolescents. It provides transferrable building blocks for cooperative planning, implementation, and monitoring of community engagement strategies and activities. The emphasis is on a practical "how to” application of the methodology of working together that features 6 steps: assess and identify; initiate and formalise; plan and resource; collaborate and implement; document, review, and monitor; and messaging for broader impact. Throughout the toolkit there are more than 30 accompanying exercises and templates to support the step-by-step process.

Following Section A, which explains how to use the toolkit, Section B provides guidance on how to build a collaborative relationship between a clinic and a CBO. Section C provides illustrative examples and stories of what activities clinic-CBO partnerships can undertake together, showing how these activities map to the PMTCT and paediatric HIV treatment cascade. Also included are 6 spotlights highlighting real-world examples of clinic-CBO partnerships. Throughout the toolkit are tools, templates, examples, guidelines, and lessons learnt from C3 and other programmes. Because the intent is to promote and encourage local innovation and individualised application specific to context, blank versions of the worksheets that support the learning in Section B can be found in Annex 1.

The accompanying Be Connected e-learning course aims to further scale the results of collaboration by providing an interactive, 2-hour online course that highlights key elements of the toolkit by offering insights through a practical "how to" application of the toolkit, guided by two C³ partners from Zambia - Eugene Mupakile, the Executive Director of Kabangwe Creative Initiative Association (KCIA) in Lusaka and Maureen Tembo, a midwife and nurse at the Mother, Child and Neonatal Department at Chazanga Clinic in Lusaka - with accompanying instructional and reflective videos. The course provides transferable building blocks for cooperative planning, implementation and monitoring of community engagement strategies and activities. The e-learning course can be standalone or supplemented by the more detailed content in the toolkit.

Through the toolkit and course, which were supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Aidsfonds, and Engender Health, PATA and PACF hope to continue empowering health providers as well as encouraging community-based staff and local coordinators to initiate, expand, and improve upon joint activities and action plans, in a collaborative effort to strengthen their work on paediatric and adolescent HIV. At the official launch of these 2 tools, experts in the field discussed challenges with collaboration between communities and clinics, including: appropriate remuneration and funding for cadres of lay frontline health providers; the importance of involving community leaders for sustainability; and how to capacitate and empower communities to take ownership of documentation and build stronger evidence of the work that they do. It was also noted that policymakers and donors need to be more flexible in their monitoring and evaluation requirements based on community capacity.