By Michael Gwarisa
The Zvandiri model, a peer-led program focused on children, adolescents, and young adults living with HIV aged 0-24, was launched in Zimbabwe 2o years ago mainly as a vehicle to increase and improve access to treatment and care for children and young persons living with HIV.
The model Zvandiri is implemented by young people aged 18 to 24 known as Community Adolescent Treatment Supporters (CATS). They are trained and mentored to support their peers throughout the HIV care continuum through support groups, home visits, phone call reminders, and messages.
When the Zvandiri model was introduced back in 2004, the biggest challenge young people and children faced was related to treatment. Even though antiretroviral medicines (ARVs) gradually became available, adolescents and young persons living with HIV continued to experience hidden mental challenges that ARVs or ART could not address.
A group of young people came to us back then and said they needed more than medicines,” said Nicola Willis, the Executive Director for Zvandiri during an interview with the HealthTimes.
“What they meant by more than medicine was that they wanted an opportunity to come together with other young people living with HIV. They wanted a certain kind of treatment. A treatment that could address the isolation, loneliness and the fear that they were growing up with HIV.”
Following that meeting with the young people, a support group comprising six young people living with HIV was formed and was named Zvandiri which is Shona for As I Am. The support group was started by Zvandiri together with the Ministry of Health and the National AIDS Council (NAC). The support group has grown over the years.
“Right from the beginning, we wanted to make sure that this type of support was integrated within the Ministry of Health’s response for HIV. Where clinics were providing ARVs for children and adolescents, they could also get Psychosocial Support, connecting them with peers like them and learning how to grow with HIV.”
The CATS intervention was introduced in 2009 led by the Ministry of Health and Child Care. The CATS intervention has been scaled across Zimbabwe as part of the HIV testing care and treatment program. The CATS are trained by the Ministry of Health and then are integrated within the clinics. Together with the nurses, the CATS provide information, counseling and support for other young people living with HIV.
Their role has also expanded as they now help young people access testing, wellness, screening for Tuberculosis (TB) and also referring TB cases to health facilities. They also provide information to support young people’s Sexual Reproductive Health.
Impact of Zvandiri in Zimbabwe
Zvandiri has conducted research to inform the strengthening of the program as well to evaluate if the model is making any impact in Zimbabwe.
“What we found is that young people in Zvandiri are much more likely to have a suppressed Viral Load, and we found a 60 percent reduction in symptoms of depression and anxiety in young people in the program. We also have robust evidence that young people supported in this program do better in terms of their HIV treatment and also their mental health. Zvandiri research has also shown that the model is cost-effective.” said Willis.
Over the past few years, a number of African countries noticed the impact the Zvandiri model was having on Zimbabwe’s young persons living with HIV. Also having similar challenges on how to support the children and adolescents living with HIV, they approached Zvandiri in Zimbabwe in order to learn how best they could implement the program in their home countries.
To date, the Zvandiri model has been adopted in 13 other countries across sub-Saharan Africa. These include Rwanda, Tanzania, Zambia, South Africa, Uganda, Namibia, Mozambique, Angola, Eswatini, Nigeria, Ghana, Cote d’Ivoire, and South Sudan.
The 14 countries recently gathered in Harare, Zimbabwe to reflect on the progress made regarding Zvandiri and find better ways to scale the model in order to ensure the services reach all affected young people. All the countries have CATS in their localised form. In Cote d’Ivoire, the CATS are referred to as AJCAT, while Namibia refers to them as NATS for Namibian Adolescent Treatment Supporters. Collectively, the Zvandiri model has ensured that 235,000 children and adolescents are reached with services.
The Rwanda Zvandiri Experience
In Kigali, the Capital of Rwanda, children and young people living with HIV can now hope for a better tomorrow. Through the works of Fiona Niwowegusa, a Community Adolescent Treatment Supporter (CATS) mentor, and her peers, several adolescents and young people have been linked to care and other essential health services in her country.

Rwanda started implementing the Zvandiri model of care in 2019. The program involves supporting the Rwandan government to deliver services to young people living with HIV through trained peers known as CATS who support them. These are usually aged 18 to 24 years.
Fiona started as a CATS Mentor since she is one of the few young persons from the 14 countries who had received training from the Zimbabwean Zvandiri team and the Zimbabwean Ministry of Health.
“When we stared at the baseline, we had a 51 percent Viral Load Suppression, and in 2021 we had a mid-line and it went from 51 percent to 83 percent. In 2023, Viral load suppression went from 83 percent to 90 percent,” said Fiona.
In January 2024, Rwanda also became the second country to be accredited by Zvandiri to continue implementing the Zvandiri program at scale, following an end-line assessment.

“We adopted the CATS project in 2019 right before COVID-19 started. We started with 11 CATS in 10 health centres in Kigali. The reason why were only in the City is because that is where most young people were located according to data from the Rwanda Biomedical Centre (RBC), an agency affiliated with the Rwanda Ministry of Health,” added Fiona.
Unlike most countries, when Rwanda commenced the program, they covered children aged Zero to 27 in order to accommodate those who had fallen through the cracks without accessing services.
“We started by delivering services for children adolescents and young people but for our country, it’s kind of exceptional because we were from Zero to 27 years old. The reason is that when piloting young people, we started with support groups. We noticed that some young people are already 24 or 25, they need that support which is more than medicine. They need someone who can follow them up daily. That’s why we extended to 27. At 24, we would start preparing them for graduation to leave the program.”
The Ghana Experience
Ghana, just like many African countries has a huge HIV burden in children as evidenced by the gaps in treatment coverage and treatment outcomes in children. Since 2014, Ghana has been developing some action plans. In 2019, Ghana lost lost about 24 adolescents to AIDS-related complications. However, in 2020, the same year Ghana piloted the Zvandiri model, mortality in the young ones reduced. Before the pilot year, retention on treatment was around 64%, however, during the pilot year, it increased to 96 percent.
“Since we started implementing this program, there is now a massive decline in the mortality of children who die from AIDS-related complications. There are targets for each country to reduce HIV related mortality and I can say for Ghana, the curve was going in a certain direction, but now it has turned for children and we are really moving towards the target significantly,” said Dr Raphael Adu-Giamfi, the Senior Program Officer in Charge of Pediatric and Adolescent HIV in the National AIDS Control Program of Ghana Health Service.
He further said they adopted the model after realising the huge gaps in treatment coverage and outcomes and the quality of care for children living with HIV comparing adults.
“There was a huge gap in the treatment outcomes and even the treatment coverage when it came to children. The adults were doing way better although it’s the same program managing them. In 2019, Ghana reviewed its action plans and realized that the problems of low treatment coverage and treatment outcomes persisted in children.”
During that review process, the World Health Organisation (WHO) brought in the Zvandiri team to share their model with Ghana, leading to the adoption the Zvandiri model in the West African country. Ghana has to date scaled the Zvandiri model to about 80 facilities with the Global Fund support. They use Civil Society Organisations (CSOs) to scale it up. At the initial stages, Ghana got some WHO help with the scale-up.
Beyond the Medicine
Dr Adu-Giamfi added that a program such as the Zvandiri model is giving children a second chance at life apart from the programmatic benefits of the intervention. Because children live long and fulfilling lives into their adulthood, they can now pursue their dreams and career options of their choice just like any child would.
“It’s not only the programmatic effect of the program that we are looking at. We know that the program helps with viral suppression, but improved access to treatment and care also adherence to all that. These are things or the benefits of the HIV program but beyond that, we look at this program beyond the medicine. This program keeps them alive and gives them hope so that they can achieve what they want to achieve in life. It also helps reduce external and internal stigma. During the program, they are taught how to overcome self-stigma in the first place so that nothing anybody will say will affect them or affect their education.”
Ghana is also implementing a revised model of the Zvandiri whereby the program is now offering adolescents in senior schools in boarding houses treatment and care services using their school nurses. This has reduced health-related home visits and absenteeism related to health visits. In Ghana, The Zvandiri model has reached approximately over 5000 children in Ghana.
The Future of Zvandiri and the Scale up
Even Non-Governmental Organisations (NGOs) like Zvandiri and CSOs implementing the Zvandiri model in various countries are critical in ensuring services reach the intended young people, effective scale up of the program is possible if government across Africa take the leading role.
“To scale this to all young people, we believe the process has to be led by government so that this model is built is built into the national health systems so that the peers are truly integrated as a valuable member of the healthcare team. That is what we have seen in Zimbabwe and other countries,” said Willis.
Dr Adu-Giamfi believes scaling the Zvandiri model to lowest end of society would greatly increase Africa chances of attaining the epidemic control and ending AIDS by 2030. In Eastern and Southern Africa, we have an estimated 930,000 children living with HIV, according to our 2023 estimates, and if you look at Western and Central Africa as well, the figures are infinitely high. We have a designated 400,000 children who are 15 years designated to be living with HIV. Data also shows that children in Africa remain disproportionately affected with 50% of them not being viraly suppressed.
The Zvandiri model recently introduced the Young Mentor Mother (YMM) cadre in the program. Like CATS, they are young people living with HIV but they are mothers aged 18 to 24. As young mothers living with HIV, they specifically support other young moms living with HIV. Either you are pregnant or breastfeeding. Data shows that 99 percent of the mothers supported under YMM program have HIV negative babies and only 1 percent is positive. The national Maternal to Child Transmission rate currently stands at 7 percent in Zimbabwe. The YMM model of Zvandiri was introduced in 2015 and already being piloted and implemented in other African countries such as Rwanda among others.