Africaid-Zvandiri

Over the last 13 years, the Zvandiri programme has evolved from this single support group for 6 adolescents into a comprehensive model of differentiated services for over 50,000. It has been adopted by the Government of Zimbabwe and is being scaled up nationally, providing services for 50,000 children, adolescents, and young people. Beyond Zimbabwe, the CATS component of Zvandiri is now being scaled up in Mozambique, Swaziland, and Tanzania.

Africaid Aims

Zvandiri aims to support national HIV systems to provide a comprehensive package of care for children, adolescents and young people living with HIV which is responsive to their clinical and psychosocial needs and experiences. HIV positive children and adolescents are at the heart of the programme, whereby they take the lead in designing, implementing, monitoring, and evaluating Zvandiri activities

The Zvandiri Programme

The Zvandiri programme combines community and health facility-based prevention, treatment, care and support services for children, adolescents and young people living with HIV. These services are led by trained, mentored young people living with HIV and integrated within national service delivery.

History

Africaid started in 2004 when a group of HIV positive children in Harare wanted to establish a support group where they could share experiences and develop skills for growing up with HIV. Amanda, a 14 year old girl, at the first support group meeting in 2004 said, “I am a child with HIV, but accept me as I am”, and thus "Zvandiri" (meaning “as I am” in Shona) was borne.

Over the last 13 years, the Zvandiri programme has evolved from this single support group for 6 adolescents in to a comprehensive model of differentiated services for over 50,000. It has been adopted by the Government of Zimbabwe and is being scaled up nationally, providing services for 50,000 children, adolescents and young people. Beyond Zimbabwe, the CATS component of Zvandiri is now being scaled up in Mozambique, Swaziland and Tanzania.

Partners

Africaid works with the Ministry of Health and Child Care, Ministry of Public Service, Labour, and Social Welfare, Ministry of Primary and Secondary Education, National AIDS Council, Harare City Health Department, local clinics and staff.

Locations

Africaid’s headquarters are located at Zvandiri House in Harare, Zimbabwe, but the Zvandiri programme is being implemented in 51 districts in Zimbabwe.

Programmes

Zvandiri provides a package of differentiated services for children, adolescents and young people living with HIV so that they know, understand accept their HIV status; that they start and remain on Antiretroviral treatment with understanding and confidence; that they remain engaged in treatment, care, and support services and that they feel cared for, understood, supported and valued. Services are primarily led by trained, mentored adolescents and young people living with HIV, known as Community Adolescent Treatment Supporters or ‘CATS’. CATS provide information, counseling and support for other children, adolescents and young people living with HIV through home visits, clinic visits, support groups and MHealth. Services are fully integrated within national systems and service delivery across the HIV care cascade.

HIV Testing Services

Children and adolescents in need of HIV testing services are identified by CATS through index case finding and community mobilization activities. CATS ensure they are linked to testing, then followed up so that they get the counseling, support, and services they need. Young people testing HIV negative are linked to prevention services led by the Ministry of Health and Child Care. Those that test HIV positive are supported with post-test counseling and disclosure and linked and engaged in national HIV treatment, care, and support, including Zvandiri.

ART Initiation and Adherence

Zvandiri supports the Ministry of Health and Child Care in ensuring that all children, adolescents, and young people have the information, skills, and support to help them understand HIV, ART, and adherence and to manage their healthcare. Those newly starting ART are provided with enhanced adherence support from CATS at home, clinic, support group and through SMS platforms. Counselling, monitoring, and support are then continued by CATS for all on treatment. The frequency of support is determined by the clinical and psychosocial needs of individual children and young people. CATS identify and refer those facing challenges affecting adherence and well-being and work together with the clinic to enhance the support provided.

Sexual and Reproductive Health Services

Sexual and reproductive health services are integrated within support groups and clinic visits through the provision of information and counseling so that adolescents and young people living with HIV have the knowledge, skills, and confidence to make decisions which keep them safe and healthy, are able to access the SRH services. They are linked to the services they need and provided with on-going counseling and support.

Mental Health

The mental health of children, adolescents and young people living with HIV is promoted through their engagement in child and adolescent-focused information and counseling, led by CATS as well as trained support group leaders, Zvandiri Mentors, and adolescent-friendly services in clinic. Mental health is routinely assessed and those at risk of mental health disorders are linked to services for assessment, diagnosis, and treatment. Zvandiri works together with mental health nurses to then support on-going counseling, medication support and adherence both at home and in the community.

Disability

CATS are trained and mentored to identify and refer HIV positive children, adolescents and young people living with disability, for management and support from health facilities and disability services. They provide information, counseling,and support for those with disability and their caregivers, so that they may cope with their HIV and disability, and can participate fully in their schools, homes and societies.

Social Protection

Zvandiri works together with the Department of Social Welfare to identify social protection challenges which may be affecting the health, safety, and well-being of children, adolescents and young people living with HIV. CATS identify and refer those they are concerned about to social protection services and work together with the national case management team to provide counseling and support for the child, adolescent, and their family.

Young Mothers

Adolescents and young people who are pregnant or already parents are supported with information, counseling and support for their own health and well-being, as well as that of their babies. Young mothers living with HIV are trained and mentored as young mentor mothers who support their peers through home visits and young mother support groups. They support the national programme by ensuring adolescent and young pregnant women are linked into Prevention of Mother to Child Transmission services and supported by adherence, disclosure, nutrition and SRH services.

Advocacy

Young advocates from Zvandiri are engaged at community, national and international level in speaking out for the needs of HIV positive children, adolescents, and young people. They have successfully advocated for policy change, guidance, funding, and service delivery for their peers at all levels by sharing their own life experiences, as well as those of their peers across Zimbabwe.

Capacity Building

Zvandiri works together with national ministries to strengthen the capacity of health workers, social welfare officers and teachers to provide services which are responsive to the evolving needs of children and adolescents living with HIV. This has included the development of national training curricula and the training and on-the-job mentorship of service providers. CATS co-facilitate this training and mentorship.

References

l