Adolescents living with HIV in Zimbabwe are happier with peer mentors
Community Adolescent Treatment Supporters (CATS), a type of peer mentor in Zimbabwe, are a powerful tool to improve treatment outcomes and psychosocial wellbeing for young people living with HIV.
Peer counsellors, known as Community Adolescent Treatment Supporters (CATS), were found to significantly improve the psychosocial wellbeing of adolescents living with HIV in rural Zimbabwe, and the number of young people being linked and retained in HIV care.
Young people living with HIV face unique challenges as it relates to treatment adherence – they may be forgetful, be lacking in support, or concealing their status and treatment for fear of stigma and discrimination.
In a randomised trial, researchers compared the effectiveness of Community Adolescent Treatment Supporters (CATS) services at the Zvandiri programme in rural Zimbabwe, to the standard of care from the Ministry of Health and Child Care. CATS are young people living with HIV between the age of 18 and 24 who are trained and mentored to become peer counsellors. They deliver adherence and psychosocial support services in their own communities, in health facilities and homes of other HIV-positive children, adolescents and young people.
Although previous studies have shown the CATS programme to be very effective in the capital, Harare, this is the first study to look at the impact of CATS in rural areas.
94 adolescents aged 10 to 15 were recruited for the study and randomly allocated to CATS services (intervention), or the standard of care (control). The standard of care model included monthly clinic reviews, antiretroviral treatment (ART) adherence counselling, CD4 monitoring and management of opportunistic infections, all led by either a nurse or a primary counsellor.
The intervention consisted of this same standard of care, but patients were also assigned a CATS. CATS visited once a week and provided additional HIV and ART information and counselling, they monitored their adherence and general wellbeing. In the event of a patient being unwell or having difficulties, CATS would notify their district mentor who would liaise with the adolescent’s specific clinic. The CATS were also provided with counselling by their district mentors.
Data on the effectiveness of the intervention was collected using surveys conducted at study baseline, three, six, nine and 12 months for both arms. The questionnaires were in the local language, Shona, and consisted of 71 closed-ended questions around demographics, adherence, psychological wellbeing, and linkages and care retention.
In both arms, most of the participants were female (around 60%), many of the adolescents were orphaned by both parents, and most lived in large households.
Using a point system with 4 being the highest, linkage to services within the intervention group increased from 2.38 points to 3.38 points, while retention to care increased from 3.66 to 3.74. In the control group, there was a small but statistically significant increase in linkage to care, but care retention declined over the 12 months, from 3.86 points at baseline to 3.31 points at the end of the study.
The intervention arm reported significant improvements in adherence to ART, from 44.2% at baseline to 71.8% at the end. This group was also 3.9 times more likely to adhere to their treatment than the control group.
The intervention group reported a statistically significant increase in psychosocial wellbeing outcomes including in confidence, self-esteem and self-worth (by 0.49 points). They also reported significant improvements in the quality of life, while the control group reported declines in quality of life and increase in stigma.
In their discussion, the authors note that CATS are well placed to help their peers with information and services in a confidential and safe manner. This study showed improved confidence, self-esteem and self-worth, compared to those who received the standard of care.
A noted limitation of this study is a lack of data on viral load suppression to better support effectiveness – with this particular study relying on self-reported adherence data. Two larger randomised control trials are currently being conducted in Zimbabwe to address these factors.
These study results have contributed to the knowledge around the effectiveness of CATS and have led the Ministry of Health in Zimbabwe to include CATS in a new range of differentiated care models, which are now being scaled-up countrywide.