Zvandiri—Bringing a Differentiated Service Delivery Programme to Scale for Children, Adolescents and Young People in Zimbabwe

Willis, Nicola, Napei, Tanyaradzwa, Armstrong, Alice, Jackson, Helen, Apollo, Tsitsi, Mushanvi, Angela, Ncube, Getrude and Cowan, Frances ORCID: https://orcid.org/0000-0003-3087-4422 (2018) 'Zvandiri—Bringing a Differentiated Service Delivery Programme to Scale for Children, Adolescents and Young People in Zimbabwe'. JAIDS: Journal of Acquired Immune Deficiency Syndromes, Vol 78, Issue S2, S115-S123.

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Abstract

Background
Since 2004, there has been a dramatic shift in the HIV response for children, adolescents and young people in low resource settings. Previously programmes and services were largely orientated to adults. This is now changing but there is limited evidence on how to take services for children, adolescents and young people living with HIV (CAYPLHIV) to scale.

Setting
Zvandiri is a theoretically grounded, multi-component differentiated service delivery model for children, adolescents and young people in Zimbabwe that integrates peer-led, community interventions within government health services.

Methods
Africaid analysed routine programme and other data from November 2004 to October 2017 to document Zvandiri scale up, framed by the WHO framework for scaling up interventions.

Results
Since 2004, Zvandiri has evolved from one support group in Harare into a comprehensive model, combining community- and clinic-based health services and psychosocial support for CAYPLHIV. Zvandiri was scaled up across Zimbabwe through phased expansion into 51 of 63 districts, reaching 40,213 CAYPLHIV. Evidence indicates that this approach improved uptake of HIV testing services, adherence and retention in care. The environment and strategic choices were critical when taking the model to scale, particularly nesting the programme within existing services, and capacity strengthening of service providers working jointly with trained, mentored CAYPHIV.

Conclusion
The results provide a firm foundation for programming and from which to build evidence of sustainable impact. Formal impact evaluation is needed and underway. These programme data contribute to the essential evidence base on strategic approaches to assist in planning services for this relatively neglected group.

Item Type:	Article
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 320 Child Welfare. Child Health Services. WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.7 Psychosocial aspects WS Pediatrics > By Age Groups > WS 440 Preschool child WS Pediatrics > By Age Groups > WS 460 Adolescence (General)
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1097/QAI.0000000000001737
Depositing User:	Rachel Dominguez
Date Deposited:	12 Jul 2018 14:47
Last Modified:	12 Jul 2018 14:47
URI:	https://archive.lstmed.ac.uk/id/eprint/8891

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