Supporting the health and wellbeing of children and young adults living with HIV

Chiva Conference: What we learned from Zimbabwe about Evidence-Based Psychosocial Interventions for Youth with HIV

Globally, 1 in 7 young people (YP) have a mental health diagnosis, with over half being identified before the age of 14. Rates are higher in young people living with HIV (YPLWH), with studies demonstrating rates of depression at more than twice the general population and higher rates of anxiety, post-traumatic stress disorder (PTSD) and substance misuse identified in this cohort. The relationship between mental wellbeing and achieving good HIV control is significant – it is difficult for one to exist without the other and as professionals it is vital that we look at ways in which we can support YPLWH to achieve both physical and mental wellbeing.

Speaking at the 19^th annual Chiva conference on 4 April 2025, Nicola Willis, the Executive Director of Zvandiri, shared a novel approach to tacking these issues in Zimbabwe. 

Zvandiri is a peer-based, non-profit organisation founded in Zimbabwe in 2004 with six YPLWH ‘who wanted more in their lives than just medicines and clinic visits’. They established this support group – whose name means ‘as I am,’ which in partnership with the Ministry of Health and Child Care (MOHCC) in Zimbabwe, has evolved into an innovative peer-based model, where YPLWH are trained and supported to become counsellors. The programme’s aim is to improve engagement in care, adherence to treatment, achieve undetectability and mental wellbeing.

The peer counsellors are 18–24-years-old and known as Community Adolescent Treatment Supporters (‘CATS’), Young Mentor Mums (‘YMMs’) or Young Mentor Dads (‘YMDs’) and are trained on-site and virtually, under the supervision of the local healthcare team. They work between health facilities and in the community as a vital conduit: tracing lost-to follow up cases, signposting patients in for face-to-face care, supporting patients to share their diagnosis and providing self-testing kits to those with unknown HIV status. Within the community they offer reliable information about HIV, co-facilitate support groups for YPLWH and provide support for pregnant women living with HIV to reduce rates of vertical transmission. Their digital offer includes SMS/’WhatsApp’ check-ins for pill adherence and mental wellbeing. They are also trained in the use of various screening tools, including for TB, mental health and STI risk and can link patients to social protection services where required.  

Each counsellor is under the supervision of the local healthcare team and their wellbeing is a key priority. Each has a 30–40-person caseload, with adjustments dependent on the setting (e.g. urban vs rural). They are ‘buddied up’ with other counsellors, have a monthly ‘debriefing’ and access to an online case management tool for support and professional development. Zvandiri has worked with local governments to have their counsellors work accredited in the form of a diploma, investing in skills, strengthening career prospects and national mental health provision.

The effects of the programme are impressive. It now employs 6,000 peer counsellors in 15 different countries, with their model being integrated into national health policy. Studies of the model have demonstrated improved HIV testing, treatment and care outcomes, significant improvements in virological suppression, 60% reduction in symptoms of common mental health disorders and significant cost-effectiveness per life year compared to a standard model of care.

At the time of writing, it is an uncertain time globally in terms of funding for HIV prevention, with some programmes temporarily closed due to lack of financial backing. However, these findings add to the expanding evidence that demonstrates how effective peer-led interventions are for children, adolescents and YPLWH. Disparities in care for this cohort in the UK also persist and it is vital that peer-based services are supported in all settings to achieve best outcomes for YPLWH and that research continues into the role YPLWH can play in supporting one another to ‘thrive’. 

Critical Reviewer: Dr. Verity Sullivan (Axess Sexual Health, Royal Liverpool Hospital, UK)