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.

Evaluating a multi-component, community-based programme to improve adherence and retention in care among children and adolescents living with HIV in Zimbabwe (2016-2021)

Funding source: ViiV Healthcare’s Positive Action for Adolescents Programme
Funding period: February 2016 to December 2021

In collaboration with Ministry of Health and Child Care (MoHCC), Liverpool School of Tropical Medicine (LSTM), 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 di?erentiated 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 (cRCT). 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 sta?. 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 trial (Mavhu et al. Lancet Global Health, 2020) was the first to demonstrate that peer-supported differentiated care for HIV can successfully impact HIV treatment outcomes (with a 42% reduction in virological suppression in the treatment arm). The findings were immediately taken up by the WHO to support their Adolescent HIV treatment guidelines. The intervention has been expanded across Africa and taken up by a range of implementers. A follow-on study to explore aspects that improved health outcomes has been funded by the Templeton World Charity Foundation (2021-2024).

Wakakosha: Building and Enhancing Self Worth among Adolescent Girls and Boys and Young Adults Living with HIV formative research.

Funding source: ViiV Healthcare’s Positive Action for Adolescents Programme

Funding period: January 2021 to December 2022

In collaboration with Africaid and Beyond Stigma, CeSHHAR is developing and piloting an intervention to support adolescent and young people living with HIV in Zimbabwe on the journey from self-stigma to self-worth. In a qualitative study, all participants reported HIV-related self-stigma either occasionally or frequently. Self-stigma negatively impacted the lives of these young people. They described negative self-perceptions including beliefs of worthlessness and hopelessness and negative body image. Using these findings, a curriculum was developed and delivered by trained facilitators to support adolescents and young people living with HIV work through these stressful beliefs. Inquiry-based stress reduction, music, art and creative expression are the combined methodology applied (all have been previously run separately and successfully by the investigators). Evaluation methods include pre and post surveys and interviews. Youth generated self-stigma / self-worth material such as blogs and photo diaries are used to engage household and community levels and to influence sectoral colleagues and institutional stakeholders.

Implementation of an innovative, client-centred HIV communication package for social and behaviour change for Adolescent Girls and Young Women (AGYW) with and without disabilities in Harare, Buhera and Goromonzi Districts, Zimbabwe

Funding Source: UNICEF Zimbabwe

Funding Period: June 2020 to May 2021

The project sought to design an innovative client-centred HIV communication package for adolescent girls and young women (AGYW)
The project comprised of three phases:
• The Needs assessment which sought to map existing knowledge of HIV risk, prevention and identify gaps in comprehensive and inclusive access to accurate HIV information and services
• The package development and roll out in 12 communities in three districts
• The pre and post intervention assessment to assess the impact of the intervention

Meeting the evolving needs of adolescents living with HIV to improve their outcomes as they transition towards adulthood: Implementation of an informal and innovative ‘transitional package’ with a focus on adolescent tailored messaging around the importance of adherence.

Funding Source: UNICEF Zimbabwe
Funding Period: June 2020 to August 2021

As viral load testing become more routinely available and accessible as the standard of HIV care in Zimbabwe understanding of viral load testing remains limited among adolescents living with HIV (ALHIV). The project sought to develop educational resources that would be accessible and appealing to ALHIV around the importance of adherence to HIV treatment and maintaining an undetectable viral load.

In partnership with Africaid the project is developing two short visual animations, comic books and picture cards to help improve viral load literacy among ALHIV. The package will be Incorporated into a Differentiated models of care (DMOC) for AYPLHIV. The project will be delivered in 20 selected districts through the countrywide Africaid Zvandiri CATS/YMM programme and though CeSHHAR’s young sex workers’ programme. Developed resources will be uploaded on the HUB; a UNICEF supported App that hosts several adolescent-focused IEC materials.

Study on the Burden of Diseases Potentially Preventable by Maternal Immunization in Sub-Saharan Africa

Funding Source: European Commission through LSTM
Funding Period: June 2018 to June 2022

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 ?rst year of life. The overall aim of the study is to quantify the burden of Group B Streptococcus, Respiratory Syncytial Virus disease, In?uenza, and Pertussis among pregnant women and their infants and evaluate how this burden is modi?ed by co-morbidities such as HIV or TB infection or HIV-TB co-infection.
Over 1,000 women were recruited and followed up in Zimbabwe and Ghana in 2019 and 2020. Nasopharyngeal swabs, serum samples and isolates (GBS, RSV and Pertussis) from mother and baby samples were transferred to WITS-VIDA in South Africa and Influenza samples will be sent to Public Health England for testing.

Analysis and final reporting are ongoing. We will host a virtual dissemination in 2022 with the EU and stakeholders from Europe and Sub-Saharan Africa to discuss findings and propose recommendations for potential future definition of a roadmap of maternal immunisation policies in sub-Saharan Africa in collaboration with the WHO, Ghana and Zimbabwe.

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.