Africaid Zvandiri was granted $156,250 over 24 months to help improve linkage and retention, adherence, disclosure and mental health among adolescents with HIV in rural Zimbabwe for 1000 adolescents and young people.
As AIDS-related deaths decrease worldwide, mortality rates continue to increase in adolescents with HIV. Adolescents with HIV face unique challenges throughout the HIV care cascade, impacting diagnosis, linkage and retention, adherence, mental health and sexual reproductive health and rights. In 2015, Africaid, with support from the Foundation’s Secure the Future programme, implemented an operational research study to measure the effectiveness of a peer-led, community-based intervention for improving retention, adherence and psychological outcomes in HIV-positive adolescents in rural Zimbabwe. Fifty 10-15 year-olds on ART received a 12-month peer-led intervention involving weekly home visits by a trained, mentored Community Adolescent Treatment Supporter (CATS) and monthly support groups, compared with fifty 10-15 year olds receiving standard care at the clinic. Qualitative and quantitative data was collected monthly to measure retention in care, self-reported adherence and psychosocial well-being.
Interim results suggest that this intervention has had a positive impact across all outcomes. Intervention participants report improved adherence (60% never missed taking medicines compared to 0% in the control group) and psychosocial well-being following engagement with a CATS (97.3% in intervention to 59.7% in control). Retention in a support group was 90% and healthcare workers report improved attendance at clinic visits compared with standard care. Disclosure of HIV status to participants by caregivers was improved (100% of participants who were unaware of their status at the start of the study were disclosed to compared to 0% in the control group).
These interim results provide compelling evidence that this adolescent-led intervention is effective in improving self-reported adherence, psychosocial well-being and retention in a rural district in Zimbabwe. Furthermore, the Ministry of Health and Child Care has adopted the Zvandiri model, including the CATS intervention, as a national model for adolescents with HIV. The Provincial Medical Director for Gokwe South District has also requested that Zvandiri be scaled up across the district. Similarly, the Medical Research Council of Zimbabwe who approved the study has also recommended that services now be implemented in Gokwe upon completion of the study in November 2015.
Gokwe South District, in Midlands Province of Zimbabwe, was initially chosen for the operations research study as it is a rural community, and it was important to measure the adaptability of an urban-based Zvandiri model within a rural district. Furthermore, there were no other existing community interventions being implemented for adolescents with HIV at the time. This continues to be the case beyond the operations research study sites.
Africaid Zvandiri aims to integrate community and health facility-based CATS while strengthening the capacity of healthcare workers and facilities to provide evidence-based, quality adolescent-friendly services for 1,000 10-19 year olds accessing HIV treatment and care in Gokwe South District. This project will strengthen the knowledge, skills and competencies of healthcare workers to address the evolving needs of young people growing up with HIV.
The project will work to ensure effective linkage of young people attending health facilities to community-based interventions. This process will be documented to help scale up services and replicate this model across 20 clinics in the district. Each of the 20 clinics will identify two young people (18-23 years old) living with HIV to be trained and mentored by Africaid in order to become CATS and help continue the project.
Monitoring and evaluation of this project will include baseline and end line capacity assessments in the health facilities across Gokwe South District as well as quarterly visits to ensure the project activities are on track and in accordance with the grant agreement.
- Adolescents living with HIV in Gokwe South District (including existing CATS and support group members from the operations research study)
- Ministry of Health and Child Care
- Ministry of Public Services Labour and Social Welfare
- National AIDS Council
- Gokwe South Rural District Council
- Gokwe South Community Stakeholders