Bridging The ART Access Gap During A Pandemic, CATS Hold The Fort In Zimbabwe

WHEN the COVID-19 was reported in Zimbabwe in 2020, government announced a national lockdown with the view of curbing the spread of the virus and limiting community transmissions. In the process other essential health services were also locked down, leaving People Living with HIV (PLHIV) especially young people living with HIV and on Antiretroviral Therapy (ART) at a disadvantage.

By Michael Gwarisa recently in Mashonaland East

With tight restrictions, fears of young people on ART falling by the wayside were rife as in most cases, young people would shun visiting health centers for fear of being embarrassed at police checkpoints where they would regularly be asked to disclose their HIV statuses and reasons for travelling. According to the Ministry of Health and Child Care (MoHCC) data, there is an increasing rate of new infections especially in adolescent girls and young women (AGYW) and children and particularly adolescents, have fallen behind in the HIV response worldwide.

In Marondera District, Mashonaland East province as well as more than 30 other districts countrywide, young people living with HIV known as Community Adolescent Treatment Supporters (CATS) have taken it upon themselves to ensure that their peers living with HIV never lack in terms of treatment and other HIV related health services and during the pandemic, they went out of their way to ensure the cycle continues.  The CATS model, a voluntary initiative comprises of 18-24 year-old HIV positive adolescents and young people and is funded by PEPFAR and USAID with Africaid as the implementing partner through support from the health ministry.

In an interview with HealthTimes on the sidelines of a National Aids Council (NAC) Editors and Station Mangers media tour, Munyaradzi Zinyanya, a CATS volunteer in Marondera district said he would ride a bicycle to collect Antiretroviral (ARV) medications from health facilities and deliver to his counterparts during the pandemic.

During the COVID-19 times at the peak of it last year, we worked together with our peers to collect medications for our counterparts who are living with HIV but were not able to collect medications due to various reasons ranging from fear of stigma, tight restrictions of movement among others.

“Remember, during the lockdown period, it wasn’t easy to move around for everyone. However, we as CATS had exemption letter that allowed us to move around to collect medications and offer services to our peers. We would access the facilities anytime and for those who couldn’t travel to health facilities, we would collect their cards or books and collect medication on their behalf and deliver at their doorstep,” said Munyaradzi.

Her added that they would also facilitate viral load testing services for the young people to also ensure they keep their viral load in check.

“This helped the young people in a very big way. You find that most young people could not travel from point A to point B. At times walking to these facilities during those times was very tricky so by rendering services and bringing the services closer to home, we realized that our networks were benefiting immensely and issues of young people who default on ART are now very low contrary to what was anticipated when the COVID was reported in the country.”

According to the Zimbabwe Global AIDS Monitoring (GAM) report of 2021, the CATS model retained more PLHIV into care compared to other models. According to the report, CATS retained a total 94597 compared to 33279 that retained by Community Art Refill Groups (CARGS), 14138 (CATFs) while other care models retained 13044.

*Sharon Murozvi* who is also a CATS in Marondera said, “In our communities, we have adolescents that we support and we have devised a system of communication to ensure no one skips their medications even for a single day. We also communicate when it is time for a refill. We share and do what we call case loading.

“As for me, I talk to the adolescents I work with and remind them to collect their medications. During the lockdown last year, we would collect the medications and deliver to them but now since restrictions have been lifted, we ensure we remind them to collect their medications when their turn comes.”

Sharon has 51 adolescents under her care in Nyameni, a community in Marondera urban and Marondera districts has a total 30 CATS.

Marven Musekiwa, an Africaid/Zvandiri Associate said they use community and facility linkages programs to reach out to adolescents and young people affected and infected by HIV.

“Through the Africaid/Zvandiri program, we work with children and adolescents and young people living with HIV from Zero to 24 years of age. We provide psychosoclai support, counseling, some referrals through the community and facility linkages. We also offer health assistance through the Marowa Fund and also offer counseling services through the Peer to Peer support.

“During the lockdown period, there was mobile health support and CATS were allowed to move around going to health facilitates since they had letters that had been written and stamped by the health facility to prove that indeed they were working together with the health institution. The CATS would take their bicycles and collect medications for the young ones. Through SMS reminders, they would communicate with the adolescents to keep track and ensure they default,” said Marven.

Meanwhile, Mr Sabastain Manyengwa, the National AIDS Council District AIDS Coordinator (DAC) for Marondera District said, “The organization itself Africaid was providing PPE to these young people and they made sure that their movements again where from their homes straight to the facility specifically to collect drugs for their peers. In terms of the adequacy of PPE, they were well catered for.

“Africaid takes good care of these young ones, actually Africaid is like these people’s Medical Aid organization because whenever they breakdown, Africaid is there to give them specialized care anywhere even outside the country. They are well catered for even in terms of PPE. I was happy because as NAC, we also had our own items to support some other partners who did not have those things. However, for the young people the CATS, they had adequate equipment to use during the pandemic.”

He added that before the CATS model came on board, a sizable number of young people were defaulting and not taking their medications.

“Because of this program, the percentage has actually gone down to the extent that from the information that we gathered at the end of quarter, we are only seeing around 10 young people defaulting against a number like 100.

“We also used to have a several cases of lost to follow-up. Why? Because the young people would give false addresses and whenever we wanted to follow them up, we would miss them. Now that we have this model on board whereby young people of almost the same age group are offering services, all that has changed. They actually get the right information to the extent that the loss to follow-up is now a thing of the past.”

Marondera district has an HIV prevalence of 17% and more women (19%) are living with HIV and males (14%). Mr Manyengwa said they have introduced models that target women in a bid to reduce the  HIV burden in women such as the Sister to Sister program, the DREAMS program and Key Populations (KP) program.

HIV still remains one of the leading causes of mortality in children under five accounting for 21 percent of children deaths in Zimbabwe. The deaths among children and adolescents are most likely due to failure or delayed identification of children and adolescents living with HIV, delayed initiation on ART, poor treatment adherence, and low retention in care.

 

 

 

 

 

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