With the universal access to antiretroviral therapy (ART) perinatally infected children missed by the PMTCT interventions are surviving into adolescent. This historically specific cohort face numerous challenges including disclosure, adherence to lifelong ART and sexual and reproductive health.

Funding Source: ViiV Healthcare’s Positive Action for Adolescents Programme
Funding period: February 2016 to December 2020

In collaboration with Ministry of Health and Child Care, Liverpool School of Tropical Medicine, Africaid, London School of Hygiene and Tropical Medicine and the University of Zimbabwe College of Health Sciences, CeSHHAR Zimbabwe evaluated the Zvandiri (As I am) programme.

The Zvandiri programme is a model of differentiated clinical service delivery for HIV positive children and adolescents in Zimbabwe. CeSHHAR evaluated the programme in two districts (Bindura and Shamva) in Mashonaland Central province using a cluster-randomised controlled trial. Sixteen clinics were randomised to either enhanced antiretroviral therapy (ART) adherence support or standard of care. Eligible individuals (HIV positive adolescents aged 13-19 years and eligible for ART) in both arms received ART and adherence support provided by adult counsellors and nursing staff.

Adolescents attending intervention arm clinics were additionally invited to attend a monthly support group, allocated to a designated Community Adolescent Treatment Supporter (CATS), and followed-up through short message service (SMS) and calls plus home visits. The type and frequency of contact was determined by whether adolescent was ‘stable’ or in need of enhanced support. Stable adolescents received a monthly home visit plus a weekly, individualised, SMS. An additional home visit was conducted if participants missed a scheduled clinic appointment or support group meeting. Participants in need of further, enhanced, support received bi-weekly home visits, weekly phone calls and daily SMS. Caregivers of adolescents in intervention attended a caregiver support group. Adolescents recruited to the trial had a clinical, behavioural and psychological assessment at baseline and after 48 and 96 weeks.

At 96 weeks, 52 (25%) of 209 adolescents in the Zvandiri intervention group and 97 (36%) of 270 adolescents in the control group had an HIV viral load of at least 1000 copies per ?L or had died (adjusted prevalence ratio 0·58, 95% CI 0·36–0·94; p=0·03). In the trial, we observed high rates of virological failure (defined as at least one HIV viral load result of ?1000 copies/?L over 96 weeks) in both arms of the trial (31.2% in the control arm; 13.2% in the Zvandiri arm). We hypothesise that some of these failures were likely due to drug resistance. We are now testing dried blood spot samples collected from all cluster-randomised controlled trial participants (N=189) who had a viral load ?1000 copies/?L at 48 and/or 96 weeks for ART resistance.

Funding Source: ViiV Health Foundation
Funding Period: April 2019 to December 2019
In 2017 WHO published an alert about the possible risks of taking dolutegravir (DTG) during pregnancy of increased chances giving birth to a baby with spinal bifida. The intervention arms of Odyssey involve participants being put onto DTG.
• The trial sites conducted specialized counselling to advise participants about the DTG
alert.
• Clinic staff explained the nature of the risks and counseled all sexual active female
participants to take contraception.
The study sought to explore young people and their caregivers’ understanding of the
dolutegravir (DTG) alert and their sexual and reproductive health (SRH) needs within the
context of the ODYSSEY trial.

Data collection was completed in January 2020 and data analysis and write up is ongoing.

Funding Source: UNICEF/Africaid
Funding Period: July 2018 to June 2019

The Zvandiri programme (run by Africaid) is a model of differentiated service delivery for
children, adolescents and young people (0-24 years) living with HIV in Zimbabwe.

• In 2018, young mothers, 18-24 years, living with HIV were trained and supported in 4 districts to act as Young Mentor Mothers (YMM) to provide enhanced care and support to vulnerable mother-baby pairs, within the Zvandiri programme.
• This holistic model uses peer led counselling, home visits, daily SMS contact, referrals and integration into adolescent friendly mother-baby support groups.

The study sought to understand the clinical and psychosocial status, virological and immunological characteristics and service delivery needs of young HIV infected mothers aged 15-24 years.

Funding Source: European Commission through LSTM
Funding Period: June 2018 to January 2020
This is a multi-country (Zimbabwe and Ghana), population-based prospective cohort study that will follow-up mothers from pregnancy until childbirth; and their infants for at least the first year of life. The overall aim of the study is to quantify the burden of group B streptococcus, respiratory syncytal virus disease influenza, and pertussis among pregnant women and their infants and evaluate how this burden is modified by co-morbidities such as HIV or TB infection or HIV-TB co-infection.

In 2018 the following activities were done:
• Site inspection visit by the LSTM
• CeSHHAR team trained by the LSTM team on data and sample collection
• NMRL lab personnel trained at the Respiratory and Meningeal Pathogens Research Unit in SA on Group B Streptococcus (GBS identification and Isolation)
– The training was a key activity towards ensuring expertise is available in study sites and processes are standardized.
– The laboratory training will contribute significantly to improvement of Isolation and identification Of GBS in the National Reference laboratory.
• 235 pregnant women and 23 infants were recruited

Completed Studies under Adolescence

  1. ARROW study: explored how the experience of life-long HIV and ART interplays with everyday life, including youth transitions to adulthood and access to social support.
  2. Third Generation Study: explored the clinical, immunological and psychosocial status of perinatally-HIV-infected young mothers at the time of their first pregnancy and its implication for their ‘third generation’ babies in Harare.
  3. Validation of mental health scales for adolescents: this study seeks to validate mental health and depression screening tools among adolescents (12-17 years). Validated tools will assist primary health care providers in the diagnosis and management of common mental disorders.
  4. REALITY social science study: the study is exploring participants’ experiences around the pill burden when starting ART and the reasons for late presentation.
  5. Lablite Policy study: examines the extent to which clinical trial findings informs policy for example the DART and ARROW trials. The trials recommended decentralization of ART with limited laboratory monitoring.