Figures & Tables
Figures
- FIGURE 1.
The Zvandiri Model of Care Involving the Community Adolescent Treatment Supporters in Zimbabwe
Abbreviations: ART, antiretroviral therapy; CATS, community adolescent treatment supporters; HTS, HIV testing services; PLHIV, people living with HIV; PMTCT, prevention of mother-to-child transmission of HIV; PSS, psychosocial support; SRHR, sexual and reproductive health and rights; SMS, short message service; TB, tuberculosis.
Tables
- TABLE 1.
Description of Community Adolescent Treatment Supporters in the Africaid Zvandiri Program in Zimbabwe
Who are CATS? Adolescent and young adults living with HIV (18–24 years old) trained and mentored by MOHCC and Africaid as peer counselors Who appoints CATS? Health care facility staff identify PLHIV (18–24 years old) with the potential (willing, competent, and motivated) to be CATS and then appoint them in consultation with the authorities in the MOHCC and Africaid. CATS should have completed secondary school and must have consent from their caregivers to enroll. How many CATS per health facility? Although the number of CATS per health facility depends on the number of children, adolescents, and young adults living with HIV who need support, the aim is to at least have 1 male and 1 female CATS per health facility. Each CATS should support between 30 and 60 children, adolescents, and young adults living with HIV at any given point in time. What training do they receive? All CATS receive 2 weeks of MOHCC-endorsed training on knowledge related to pediatric and adolescent HIV (HIV, ART, adherence support, disclosure, sexual and reproductive health, protection, psychosocial support, and mental health) and skills in counseling and community outreach. The training combines theory and practical components, which includes hands-on mentorship (‘shadowing’) by senior CATS for a period of time before they are independently able to provide support. Training is participatory and uses case studies and role plays. They also receive technical support from district-based Zvandiri mentors employed by Africaid. This initial training is then followed by continued on-site training and mentorship. What are their responsibilities? Cofacilitate monthly support groups and ART refill groups
Conduct home visits for counseling, monitoring, and support
Send SMS reminders and phone calls for adherence and clinic visits and check-ins
Provide counseling in clinic and link to other services as needed
Refer children, adolescents, and young adults living with HIV (particularly severe cases) and link to other service providers including OI/ART, mental health, social protection, disability, SRHR, and PMTCT
Perform community outreach visits in partnership with other cadres from health and social protection
Cofacilitate caregiver workshopsWho supervises and mentors CATS? A nurse or primary counselor at the clinic supervises CATS with additional supervision and mentorship by the district Zvandiri mentor. A district-level monthly meeting is conducted to mentor and review progress of CATS. What remuneration and incentives do they receive? Fixed allowance of US$20 per month
Bicycles to facilitate home visits and/or reimbursement of bus fare
Monthly airtime allowance for SMS reminders and callsAbbreviations: ART, antiretroviral therapy; CATS, community adolescent treatment supporter; MOHCC, Ministry of Health and Child Care; OI, opportunistic infection; PLHIV, people living with HIV; PMTCT, prevention of mother-to-child transmission of HIV; SMS, short messaging service; SRHR, sexual and reproductive health and rights.
- TABLE 2.
Components and Levels of Support Provided by CATS to Children, Adolescents, and Young Adults Living With HIV in the Africaid Zvandiri Program, Zimbabwe
Standard Zvandiri Support Enhanced Zvandiri Support Eligibility criteria Undetectable viral load or CD4 count >500 cells/ml in the last 6 months
Attended all scheduled clinic visits in the last 3 months
Psychologically stable
Safe
A detectable viral load or CD4 count <500 cells/ml in the last 6 months
Failed to attend scheduled clinic visits in the last 3 months
Psychological distress
Abuse or neglect
Started ART in the past 3 months
Reported nonadherence
Pregnant
CATS-led interventions Monthly home visit
Weekly SMS reminders
Clinic-based counseling
Referrals and linkages, particularly for severe cases, to other service providers
Home visit every 2 weeks
Daily SMS reminders
Clinic-based counseling
Referrals and linkages, particularly for severe cases, to other service providers
CATS-supported interventions Monthly support group
Caregiver workshop
Monthly support group
Caregiver workshop
Adherence workshop
Community outreach with CHWs/CCCWs
Abbreviations: CATS, community adolescent treatment supporters; CHWs, community health workers; CCCWs, child case care workers.
- TABLE 3.
Demographic Characteristics of the Household Contacts and Sexual Partners of Index People Living With HIV Identified by Community Adolescent Treatment Supporters in 24 Districts of Zimbabwe, October 2017–September 2018 (N=15,523)
Characteristics No. (%) Age (years) 0–4 2495 (16.4) 5–9 2814(18.5) 10–14 3170 (20.8) 15–19 3830 (25.2) 20–24 2914 (19.1) Gender Male 6597 (43.3) Female 8626 (56.7) Type of Contact Sibling 6229 (40.9) Sexual partner 290 (1.9) Children 8704 (57.2) Province Bulawayo 1567 (10.3) Harare 685 (4.5) Manicaland 4489 (29.5) Mashonaland Central 1076 (7.1) Mashonaland East 179 (1.2) Masvingo 1362 (8.9) Matabeleland South 1871 (12.3) Midlands 3994 (26.2) - TABLE 4.
HIV Care Cascade Among Household Contacts and Sexual Partners of Index PLHIV Identified by Community Adolescent Treatment Supporters in 24 Districts of Zimbabwe, October 2017–September 2018 (N=15,223)
No. (%) HIV Testing Outcome Contacts Referred for HIV Testing 15,223 (100.0) Contacts tested for HIV 12,114 (79.6) Contacts tested who were HIV-positive 1,193 (9.8) HIV-positive contacts who initiated ART 1,153 (96.6) ART Outcomes 3 months Alive on ART 1,153 (100.0) 6 months Alive on ART 1,151 (99.8) Died 2 (0.2) 12 Months (n=569a) Alive on ART 566 (99.5) Died 2 (0.4) Lost to follow-up 1 (0.2) Viral suppression (<1000 copies/ml) 1,037b (99.3) Abbreviations: ART, antiretroviral therapy; PLHIV, people living with HIV.
↵a Number of contacts eligible for 12-month assessment; People whose duration between ART start date and censor date was less than 12 months were considered not eligible for assessment.
↵b Among 1,044 contacts who had a viral load test at 6 months or later after starting ART.
- TABLE 5.
Factors Associated With Not Testing for HIV Among Household Contacts and Sexual Partners of Index PLHIV Identified by Community Adolescent Treatment Supporters in 24 Districts of Zimbabwe, October 2017–September 2018
Characteristic Total Referred for HIV Testing Not Tested for HIV Crude RR(95% CIa) Adjusted RRb(95% CIa) No. No. (%) Total 15223 3109 (20.4) Age (years) 0–4 2495 864 (34.6) 13.63 (10.82–17.18) 12.72 (10.01–16.17) 5–9 2814 775 (27.5) 10.84 (8.59–13.68) 10.41 (8.19–13.23) 10–14 3170 867 (27.4) 10.77 (8.54–13.58) 10.20 (8.03–12.96) 15–19 3830 529 (13.8) 5.43 (4.28–6.90) 5.21 (4.08–6.65) 20–24 2914 74 (2.5) Ref Ref Gender Male 6597 1456 (22.1) 1.15 (1.08–1.22) 1.05 (0.98–1.13) Female 8626 1653 (19.2) Ref Ref Type of contact Sibling 6229 1289 (20.7) Ref Ref Sexual partner 290 12 (4.1) 0.19 (0.11–0.34) 0.51 (0.29–0.91) Children 8704 1808 (20.8) 1.00 (0.94–1.06) 1.04 (0.96–1.12) Province Masvingo 1362 55 (4.0) Ref Ref Bulawayo 1567 365 (23.3) 5.76 (4.38–7.58) 7.27 (5.47–9.67) Harare 685 2 (0.3) 0.07 (0.01–0.29) 0.08 (0.02–0.36) Manicaland 4489 1321 (29.4) 7.28 (5.60–9.47) 7.36 (5.62–9.65) Mashonaland Central 1076 75 (7.0) 1.72 (1.23–2.42) 1.73 (1.22–2.45) Mashonaland East 179 9 (5.0) 1.24 (0.62–2.47) 1.34 (0.66–2.72) Matabeleland South 1871 812 (43.4) 10.74 (8.25–13.99) 11.84 (9.00–15.57) Midlands 3994 470 (11.8) 2.91 (2.21–3.82) 3.32 (2.51–4.40)
In this issue
Statistics from Altmetric.com
Jump to section
Related Articles
Cited By...
- No citing articles found.