The Zvandiri Programme Findings from a community peer support treatment intervention Nicola Willis Africaid, Zimbabwe

Zvandiri Started as 1 support group for ALHIV in 2004 “Zvandiri” – “As I am” in Shona Community HIV prevention, treatment, care and support for children, adolescents and young people, 6-24 yrs Integrated within health facility services Differentiated service provision Adopted and scaled up by the Government of Zimbabwe

Community Adolescent Treatment Supporters (CATS) HTS mobilisation Index case finding Linkage to HTS and follow up Identification and linkage to OI/ART services Community ART counselling, monitoring and support Support Groups Identification and referral for OIs, treatment failure, child protection, mental health, SRH Tracing loss to follow SMS Reminders Young mothers groups Vocational skills Linkage with Clinic, Village Health Workers, Social Workers, Case Care Workers, Community Nurses Training and mentorship for health care workers, social welfare, teachers and caregivers Standard, Enhanced, Intensive

What we have learned? An operations research study to measure the effectiveness of the CATS service in Gokwe South District, Zimbabwe N. Willis, C. Dziwa, M. Mawodzeke, C. Chitiyo, S. Munyonho, A. Milanzi, I. Yekeye, Chemhuru, P. Mtshali, B. Mohr, V. James Study Objectives: To measure the effectiveness of a community-based, adolescent-led treatment support and psychosocial intervention in improving retention in care adherence psychosocial well-being 50 adolescents on ART receiving standard of care vs 50 receiving standard of care plus CATS Rural district of Zimbabwe

What we have learned? Adherence Improved adherence from 44.2% at baseline to 71.8% at endline (p- value=0.0087) in those receiving CATS services 3.9 times more likely to adhere to treatment compared to the control group (OR=3.934) It is now my desire to keep the virus supressed because I really know now how these ARVs work. Even when you are well I have learnt the importance of taking ARVs from the CATS who visit me at home. My grandmother loves this CATS as they have really supported me and am no longer having challenges to adhere to my ARVs. (Adolescent, Krima Clinic) I used to throw away my medicines not adhering at all, but ever since I received support from the CATS I am now adhering to my medicines (Adolescent, Sesame) Mabel always checks on me so I now understand the reason why I need to adhere so I thank her for the support. She is my pillar of strength.(Adolescent, Krima)

What we have learned? Linkage and Retention Improved linkage and retention among those receiving CATS services “CATS link adolescents to HTS, OI services, family planning and for clinical assistance. They feel more comfortable now accessing servicea and generally linkages to services has improved” (District Medical Officer) “The CATS programme has resulted in reduced loss to follow up since each CATS has a number of children he or she looks after and follows up on” (Sister in Charge, Health Clinic)

What we have learned? Increased self esteem, confidence and self worth in those receiving CATS services This intervention has done something magical for these adolescents. Now they have this confidence in them. (Nurse, Sesame Clinic)

Next Steps Scale up in to 36 districts of Zimbabwe under the Accelerated Action Plan for Treatment for Children and Adolescents Two randomised control trials commencing now: – Cluster randomised trial of the Zvandiri Programme, a multi-component, community-based programme to improve adherence and retention in care among children and adolescents living with HIV in Zimbabwe (MoHCC, CeSSHAR, ViiV Health Care) – The Peer Support Intervention – supporting HIV positive adolescents in Zimbabwe to improve HIV care continuum outcomes among adolescents with virological failure (MoHCC, UZCHS, JSI/USAID)

Thank you Children, adolescents and young people of Zvandiri International AIDS Society Ministry of Health and Child Care, Zimbabwe National AIDS Council, Zimbabwe NEDICO, Zimbabwe Bristol Myers Squibb Foundation ELMA