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.
1. A CRT to evaluate the cost-effectiveness of the Zvandiri programme with HIV-positive adolescents
Funding Source: Viiv Healthcare Limited
Funding Period: September 2015 to August 2019
Between 2005 and 2012, HIV-related deaths among adolescents increased by 50%, while the global number of HIV-related deaths fell by 30%. This increase in adolescent HIV-related deaths is largely due to poor prioritisation of adolescents in national HIV plans, inadequate provision of accessible and acceptable HTC and treatment services and lack of support for adolescents to remain in care and adhere to antiretroviral therapy (ART). The Zvandiri programme is a community-based psychosocial support program for positive adolescents in Zimbabwe which has been documented as a UNICEF and SADC best practice. The programme uses peer adolescent counsellors to deliver support groups and tailored community-based adherence counselling support plus counselling for the broader psychosocial issues these young people are facing. The Zvandiri programme also includes an intervention for caregivers. The programme has demonstrated feasibility and acceptability. We propose to conduct a cluster randomised trial of the Zvandiri ('As I am') programme (http://www.africaid-zvandiri.org/) in order to generate evidence of its effectiveness and cost-effectiveness.
We hypothesise that children and adolescents living with HIV who receive care at health facilities supported by the Zvandiri programme will have better HIV treatment, retention and prevention outcomes than those attending facilities without Zvandiri support. We therefore propose to evaluate the programme in a cluster randomised trial. This trial will provide evidence on whether enhancing community-based support for adolescents on ART will i) improve retention in care and ii) reduce the cumulative incidence of ART treatment failure at 48 and 96 weeks when compared to usual support. It will also provide evidence on whether this intervention reduces psychological distress and rates of non-disclosure to sexual partners at 48 and 96 weeks. We anticipate the Zvandiri programme will improve adolescents’ physical and psychological health resulting in improved clinical outcomes, quality of life and reduced sexual risk taking.
2. The CHIDO Trial – evaluating a complex community intervention delivering parental stimulation, economic strengthening and support for HIV retention and care among HIV infected mothers and their 0-2-year-old infants
Funding Source: USAID OVC Special Initiative through World Education
Funding period: April 2014 – September 2017
Studies on children infected and affected by HIV have clearly shown poorer child development outcomes than uninfected and unaffected children. The global literature has documented a number of factors associated with poorer child development outcomes, and many of these are present or even elevated in high HIV affected groups, such as depression, anxiety, trauma, poverty, separations, alcohol use, drug use, reduced stimulation, parenting factors, poor attention, and low levels of support. The specific aims of this trial are to pilot a comprehensive, community-based intervention programme aimed at improving childhood development, strengthening household economic resilience, enhancing adherence and retention in paediatric HIV care and treatment programmes amongst caregivers and their HIV exposed children aged 0-2 years old in Zimbabwe and modify the intervention in line with findings, and to evaluate the final intervention’s effectiveness and disseminate findings to influence policy and programming in Zimbabwe.
3. Families Matter! Programme: An intervention to promote effective parent-child communication about sexuality education and sexual risk reduction among families in Zimbabwe: a Programme Evaluation
Funding Source: CDC Zimbabwe
Funding Period: July 2015 to May 2017
The Families Matter! Programme (FMP) is a community-based intervention designed to be delivered over five consecutive weeks in three-hour sessions to promote positive parenting practices and effective parent-child communication about sexuality and sexual risk reduction for parents and other caregivers of children aged 9-12 years. Currently being implemented in seven sub-Saharan countries, FMP recognizes that many parents may need support to effectively convey their values and expectations about sexual behaviour and to communicate important messages about HIV, sexually transmitted infections (STIs), pregnancy, child sexual abuse, and gender-based violence to their children. The ultimate goal of FMP is to reduce sexual risk behaviour among adolescents, including delaying sexual debut, by providing parents and caregivers with the knowledge, confidence, and parenting strategies to deliver primary prevention messages to their children and protect them from child sexual abuse and harmful gender norms that may lead to violence. Recently, a number of updates were made to the FMP curriculum in order to keep it as current, beneficial, and culturally attuned as possible. These enhancements include: content specific to child abuse (including physical, emotional, and sexual abuse); gender-based violence (GBV) and gender norms; the addition of a sixth session which specifically addresses child sexual abuse (CSA); strengthened direct linkages to HIV services including HIV testing and counselling; prevention of mother to child transmission, and voluntary medical male circumcision.
Completed Studies under Adolescence
- 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.
- 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.
- 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.
- REALITY social science study: the study is exploring participants' experiences around the pill burden when starting ART and the reasons for late presentation.
- 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.