Zvandiri is an evidence-based holistic model of care and support for children, adolescents living with HIV, led by young people living with HIV who are trained and mentored as peer counsellors known as Community Adolescent Treatment Supporters, Young Mentor Mums and Young Mentor Dads. Zvandiri has been designed, delivered, developed and scaled over the last 19 years. It is informed by evidence from our programme data, evaluations and research and the lived experiences and needs of the young people we work with. This has shaped the work of Zvandiri and strengthened the evidence-base for global and national guidelines, service delivery and resources allocated for paediatric and adolescent HIV and mental health.
The Zvandiri Trial is a research study conducted to measure the impact of the model on HIV treatment outcomes among adolescents living with HIV. Led by CeSHHAR in collaboration with LSHTM, LSTM, University of Sydney and Kings College, and funded by ViiV HealthCare, this study set out to address the lack of evidence for peer-led interventions for adolescents. The two-year study was carried out with 496 participants in two districts of Zimbabwe, Bindura and Shamva. The study found that adolescents engaged in the Zvandiri programme and supported by CATS do significantly better with their HIV treatment and have higher levels of viral suppression than those not in the programme.
It was found that the Zvandiri intervention worked because it created a support structure around the young person that acted as a safety net. Too often interventions focus on young people alone, ignoring how the environment influences their management of HIV. By connecting young people with trained peer counsellors , creating safe spaces for friendships and trusted relationships, strengthening families and making the clinic an easier place to visit, children adolescents and young people living with HIV do better.
The study adds to the growing body of evidence to support WHO’s recommendations for community-based, peer-led interventions to support ART adherence and retention in care. Our findings provide further justification for the scaling up of the Zvandiri intervention in sub-Saharan Africa.
Whereas the Zvandiri Trial measured the impact of Zvandiri on viral suppression, the Zvandiri-Friendship Bench Trial measured its impact on the mental health of adolescents living with HIV. This 12-month research study involved 840 adolescents living with HIV across ten districts of Zimbabwe, with half receiving standard CATS counselling and the other half receiving enhanced counselling from CATS trained in Problem Solving Therapy by Friendship Bench. This study found significant improvements in mental health among all young people supported by CATS. Among adolescents receiving standard CATS counselling, symptoms of common mental disorder (CMD) reduced from 72 to 10%. However, this reduction was even greater among those receiving enhanced, problem-based counselling from CATS, where CMD reduced from 68% to 2%. We learned while Problem Solving Therapy was difficult for CATS to implement with fidelity, they adapted this to problem discussion therapy which was highly effective.