For many children and adolescents living with HIV in Ethiopia, access to specialized care has long been out of reach. Health appointments and care for children living with HIV are typically managed by general health providers – rather than pediatricians – and these workers often lack specialized training to address complex pediatric cases, like those of children living with HIV.

ICAP in Ethiopia has been working to address this gap by introducing a groundbreaking tele-mentoring initiative, which connects health care providers in underserved areas with pediatric and children’s health specialists.

In Ethiopia, the limited number of pediatric HIV specialists provide services at referral teaching hospitals in urban areas and seldom work out of rural health centers and primary hospitals, where most children living with HIV receive care. ICAP’s Pediatrics HIV Care and Treatment (PHCT) project equips health care workers with support from experts, ensuring better care and health outcomes for children living with HIV and reducing unnecessary referrals to already overwhelmed hospitals.

The tele-mentoring project was first launched in Addis Ababa in 2021, with Yekatit 12 Hospital Medical College serving as the lead location working in collaboration with six health centers. Using a hub-and-spoke model, specialists at a central “hub” mentor health care workers at “spoke” sites through regular virtual sessions. Through these virtual sessions, health care workers at spoke sites discuss challenging cases, present their experiences, and receive expert advice from pediatricians. For many of the health care workers involved, the approach not only boosts their pediatric knowledge but also alleviates feelings of isolation in their work.

The early success of the program in Addis Ababa later paved the way for its expansion into the regions of Amhara, Oromia, Sidama, and Tigray, with Gambella region being the most recent to launch the virtual sessions.

“Before the Pediatrics HIV Care and Treatment project, I had no option for consultation with a senior specialist,” said Buziye Tesfa, a health care worker at Arada Health Center in Addis Ababa, who is engaged in the program. “Now, I have learned from the cases presented by others and that has enabled me to offer better care to my patients.”

“The project has helped me gain confidence and deliver better care to children taking HIV medication in our facility,” said Tsegaye Abate, a health care worker at Bole Health Center in Addis Ababa, who is also engaged in the program. “It’s a game-changer for us and for the children we serve as well.”

Using a hub-and-spoke model, specialists at a central “hub” mentor health care workers at “spoke” sites through regular virtual sessions focused on pediatric care.

ICAP has observed a number of improvements among participating health facilities since the launch of the tele-mentoring initiative. For example, nutritional assessment coverage among patients improved from 68 percent to 86 percent and viral load suppression among individuals living with HIV improved from 89 percent to 95 percent.

To ensure effective operations of the program, ICAP facilitated the supply of reliable internet and necessary equipment to the participating health facilities. This included procuring furniture, web cameras, and specialized instruments to measure, for example, a child’s height and nutritional status. ICAP also supported phone costs and secured Zoom licenses to ensure seamless communication among participants.

An evaluation conducted in Addis Ababa revealed that health care workers who were involved in the project felt more confident in managing the health of children living with HIV. Many noted that the ability to consult with pediatric experts through virtual sessions enabled them to make better informed decisions, such as adjusting HIV treatment regimens or addressing malnutrition in children living with HIV.

“After the session on nutrition, I now understand how critical it is to evaluate a child’s nutritional status at every visit,” said a health care provider involved in the program. “It makes a real difference.”

“The project’s innovative approach has proven to be a powerful tool for knowledge transfer, fostering peer-to-peer learning, and improving health care workers’ ability to manage pediatric HIV cases,” said Micahel Tilahun, ICAP’s Pediatrics HIV Care and Treatment clinical advisor. “By reducing isolation and increasing professional satisfaction, the project is paving the way for better health outcomes for children living with HIV in Ethiopia.”

About ICAP

A major global health organization that has been improving public health in countries around the world for two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 40 countries, working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies. Online at icap.columbia.edu