Tânia now dreams of one day becoming a nurse.

"Next year, I'm going back to school because when I grow up I want to be a nurse to help other people." -Tânia

Five months ago Tânia, a young girl living in Maganja da Costa district of Zambézia Province, did not dare to dream of what she would be doing next year because she was extremely ill. Back in March 2016, she had a CD4 count of just 1 unit.

"I had a sore throat. I was not able to eat. I felt very bad," says Tânia, with tears in her eyes. "But ever since I started taking the medication, nothing is sore anymore," the little girl says with an expression of hope for better days ahead.

"When I become a nurse, I will build myself a house. I would like to live in Quelimane," she dreams. This mix of despair in the past, followed by hope for the future is part of the inspirational story Tânia told us. This is a story of renewed faith, thanks to the availability of second line Antiretroviral Treatment (ART) in Maganja da Costa. Second line treatment is used as a resource in the few cases where patients on regular treatment follow all the clinical recommendations for the administration of prescribed pharmaceuticals, but their health does not improve.

"I met Tânia back in 2015. She had been taking ARV treatment for several years, but her health status simply would not improve. That called for my attention and I started closely following her case. She had small wounds all over her body; she was very frail; she coughed a lot; and was very skinny. Her situation only worsened from consultation to consultation," Josefina Supinho told us. Josefina is a Psychosocial Support Officer working for Friends in Global Health (FGH), who provides technical support in Maganja da Costa District.

Tânia is counseled by Flora Francisco, Maganja da Costa's Health Technician.

According to Flora Francisco, a health technician at Maganja da Costa Health Facility, "We tested her twice, through bacilloscopy, to see if she had tuberculosis. The result was negative. Nevertheless, we saw that she was in a really bad shape, and we started TB treatment." After Tânia stabilized, a viral load test was requested that indicated the need for 2nd line treatment.

Tânia is not sure of her age. She has never met her parents; both died when she was very young. She estimates that she is 11 years old; an age of dreams and hopes that were almost erased.

Cultural complexities of life in Maganja da Costa further destabilized Tânia’s daily life. Her aunt, with whom she had lived since her parents passed away, was already preparing for the worst. For this reason, she decided to "get rid" of Tânia by sending her to live with her sister.

"I was scared of her losing her life here at the house. I could be accused of having harmed her. That is why I preferred to have her stay with her sister. Even so, I carried on helping the girl with the little I have," says Assia Lazize, Tânia's aunt.

Today, with Tânia's health improving with the result of second line ART, Assia feels more comfortable having her niece back at her home. "She can come back to my house if she so desires. Here she can eat what I eat; she has her own bed and blanket. I have no problems," Assia says.

Tânia is now eating normally and has recovered her weight. The health personnel who assisted her during her most critical moments have no doubt that the introduction of second line ART gave Tânia a new chance at life.

"Second line ART is very important because it improves the patient’s clinical condition," says Flora Francisco. With support from PEPFAR, facilitated by FGH, the Zambézia Provincial Therapeutic ART Committee, which is responsible for reviewing complicated cases and together with the National Committee approving the initiation of second line ART for those patients who need it, is now meeting on a regular basis to ensure that those patients in need get access to the Second Line drugs in a timely manner.

Josefina Supinho explains, "It is important to ensure accessibility of those medications” as the number of patients who need them has been on the rise.

Tânia is one of the 3,908 children who were on ART in the 14 FGH-supported districts in Zambézia Province in September 2016. She is the first child in Maganja da Costa to initiate second line ART. FGH's support of second line ART is part of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) funded Avante Zambézia project through the Centers for Disease Control and Prevention (CDC). FGH is affiliated with Vanderbilt University Medical Center and provides support to Zambézia's Provincial Health Directorate for the implementation of HIV health related services. This partnership has contributed to the scale-up of ART services within the province. In September 2016, there were 51,824 adults and children actively on ART in the 14 FGH-supported districts.