Zvandiri

Eighteen years ago, I founded the 'Zvandiri' programme to improve health, happiness and hope among children and young people living with HIV in Harare, Zimbabwe. Zvandiri started with an idea, no funding and 6 adolescents in Harare. Today in 2021, it is a globally recognised, evidence-based, holistic model of HIV and mental health services implemented in 8 countries in the region and supports 56,000 children and young people. 

We know Zvandiri works. Research and program evidence confirms that young people in Zvandiri have improved health, happiness and hope compared to those not engaged in Zvandiri. We also know it is scalable, having successfully supported Governments and organisations in Zimbabwe and 7 countries in the region. 

But there is much more to do. Our vision is to expand Zvandiri to 20 countries by 2030 to deliver health, happiness and hope to 1 million young people living with HIV. We need the Elevate Prize to support us in scaling up face-to-face and digital technical assistance to these countries. This Prize will also provide invaluable organisational capacity building and networking opportunities which will strengthen our capacity to ensure quality at scale as we transform the lives of 1 million young people.  

At 8 years old, I was shown a book about sick children in Ethiopia and I decided I would work in Africa to transform the lives of vulnerable children. Ten years later, I trained as a paediatric HIV nurse specialist in England then embarked on my career. I am driven by the belief that all children with HIV should live happy, healthy, safe, fulfilled lives and for this to be achieved, a medical model of care simply isn’t enough. Young people living with HIV need holistic services which support their health and well-being. Further, I know that young people themselves are the solution. 

Having founded Zvandiri, I have spent two decades working with young people living with HIV to design and scale innovative, community and clinic-based services which address their needs. In particular, I have designed, evaluated and championed the role of trained, mentored peer counsellors, known as 'Community Adolescent Treatment Supporters'. We have shown global, national and community decision makers what young people need, what works and how to scale this up. 

My vision is to scale Zvandiri to 20 countries by 2030  to deliver health, happiness and hope to 1 million young people living with HIV.

There are 2.1 million young people living with HIV worldwide and this number continues to grow. Furthermore, whereas HIV-related deaths have fallen among adults, they continue to increase in young people. To stop this global crisis, young people need evidence-based, effective solutions which support them to accept themselves, to take their medication and to take control of their own health and well-being. 

Zvandiri, meaning “As I am”, does just this. We train and mentor young people living with HIV known as 'Community Adolescent Treatment Supporters' (or CATS). CATS connect with other young people living with HIV in their homes, communities, clinics and through mobile health to help them survive and thrive. We work with governments to deliver the Zvandiri model at scale to ensure health, happiness and hope for young people living with HIV across the country. Today there are 1600 CATS supporting 56,000 young people in 8 countries.

Zvandiri also works with families, clinics, schools and communities to nurture loving, stigma-free, supportive environments so that HIV positive young people may survive and thrive. We use a combination of face-to-face and digital platforms to do this, with CATS at the forefront of this work at all times.

At Zvandiri, we aim to be extraordinary in all we do. We dare to be bold, to be different, unusual and creative, ensuring excellence at all times. We strive to be frontrunners in meeting the evolving and dynamic needs of young people. We do this in four ways: 

1. Zvandiri embraces the power of young people living with HIV in the design, delivery, monitoring and evaluation of their own evidence-based, clinic and community interventions. We are 100% invested in the sustained capacity building and engagement of young people. 

2. Zvandiri is integrated in the national system, led by Government with technical assistance from the Zvandiri team and guided by a standardised set of training curricula, implementation tools and resources.

3. Zvandiri is informed by evidence, from our programs, research and by connecting with young people, we learn what is needed and how to be most effective. We ensure we deliver high quality interventions that allow young people to achieve their true potential. www.africaid-zvandiri.org/rese... 

4. Zvandiri is unique, ensuring young people are engaged in the development and sharing of their own creative information and resources, including their own films, books, comics, games, exhibitions, and radio show www.africaid-zvandiri.org/reso...

Our goal is to expand our Zvandiri model to 20 countries by 2030 to deliver health, happiness and hope to 1 million young people living with HIV. We have adopted three core strategies to achieving this:

1) Packaging - We have created a set of tools which guide Governments, implementing partners and CATS how to deliver Zvandiri, with focus on the provision of quality services at all times. These tools are for face-to-face and digital use, enabling the Zvandiri team to deliver sustained, long distance support, e.g during COVID-19. 

3) Partnerships - We work directly with the World Health Organisation and regional Governments to identify countries wanting to adopt Zvandiri, then to plan and deliver technical assistance. This assistance is guided by a jointly developed partnership agreement. 

4) Programme of support - We have created a standardised, two year programme of technical assistance which is delivered by the Zvandiri Technical Assistance Unit. Each country is then accredited but receives a continued, digital package of training and mentorship from Zvandiri.

This structured, standardised approach continues to ensure national ownership, investment in trained peers and an absolute commitment to quality and the scale up of Zvandiri's evidence-based model. 

CURRENT: Zvandiri provides direct support to 56,000 children, adolescents and young people living with HIV, (CAYPLHIV), 0-24 years. They are supported by 1600 trained, mentored peer counsellors (CATS) who also receive direct training, mentorship and supervision to equip them with the skills and confidence to support their peers living with HIV.

Indirectly, Zvandiri also supports at least 56,000 primary caregivers (estimated one parent / relative per beneficiary) with information, counselling and support. Zvandiri also reaches a minimum of 1,226 health care workers across 613 health facilities (estimated 2 per facility), building their capacity to provide quality HIV and mental health services to CAYPLHIV. 

IN ONE YEAR: Zvandiri will directly reach a total of 89,000 CAYPLHIV and 2,700 CATS. Indirectly, 89,000 primary caregivers and 3,426 health care workers will be reached through capacity building to support the children in their care. This scale up in one year will be achieved through:

- sustained implementation of Zvandiri in existing sites

- a new partnership in Zambia through which Zvandiri will be adopted

- scale up of Zvandiri by Global Fund and Ministry of Health and Child Care in Zimbabwe

- scale up of Zvandiri in Ghana, Namibia, Rwanda, Tanzania, Mozambique

Zvandiri ensures health, happiness and hope for young people living with HIV. This goal is stated in our Theory of Change - that children, adolescents and young people living with HIV have full physical, social and mental well-being. This is directly aligned with the UN's Sustainable Development Goal 3 - ensuring healthy lives and promoting well-being for all at all ages.

We know this goal is attainable at scale through full implementation of Zvandiri. Our goal is to expand our Zvandiri model to 20 countries within 10 years to deliver health, happiness and hope to 1 million young people living with HIV. We will achieve this through our proven model of technical assistance to Governments using a standardised on-site and digital training and mentorship programme. 

We measure progress through a monitoring and evaluation plan which tracks:

- the number of Governments adopting Zvandiri within their national programmes - target 20 countries

- the number of children, adolescents and young people receiving direct services from Zvandiri - target 1 million 

- the proportion of CAYPLHIV with suppressed viral loads - target 900,000

- the proportion of CAYPLHIV with good mental health - target 900,000

Zvandiri works and is scalable. In one year, we can improve the lives of 89,000 children, adolescents and young people living with HIV and 2,700 CATS, as well as strengthening the capacity of those who support them - 89,000 primary caregivers and 3,426 health care workers. But success requires implementation fidelity to this evidence-based model so that quality services are provided. We have developed and utilise a standardised technical assistance package for governments, implementing partners and CATS but we need to continue strengthening this approach to ensure optimal success at scale. Winning the Elevate Prize will provide us with a rare opportunity to be connected with experts we can learn from, grow and strengthen our systems, particularly around monitoring and evaluation of service delivery and impact at scale.

Additionally, we need to expand our digital platforms for providing digital training and mentorship so that we can continue to provide state of the art, engaging, effective and cost-effective technical assistance to the 10 existing countries we support as well as new countries we support in future. We know the Elevate Prize will lead to tremendous opportunities to be connected with strategic and funding partners in digital technology.

To date, Zvandiri has evolved and expanded through support from funding and strategic partners within the HIV sector. But we urgently need to diversify our partnerships if we are to a) reach our vision of 1 million young people supported in 20 countries by 2030 and b) optimise the learning and best practices from within Zvandiri. 

Through the Elevate Prize, we aim to inspire a wider audience interested in: 

1) Supporting the Zvandiri Technical Assistance Unit to provide standardised technical assistance to new countries wanting to adopt Zvandiri, thereby reaching our goal of 1 million CAPLHIV.

2) Improving our digital platforms and designing new platforms to deliver interactive, child and youth-focused training and mentorship to Governments, Health Workers, Implementers, CATS and CAYPLHIV internationally.

3) Scaling up our creative, innovative child and adolescent-friendly information, education and communications materials, including comics, animations, books, film, music and dance. These are in high demand, are highly effective and there is much more to do. 

4) Scaling up Zvandiri in to the global mental health response - Zvandiri has been proven to be an effective, youth-led, community-based, mental health intervention and could benefit young people well beyond HIV. (Zvandiri-Friendship-Bench Trial, in Press)

Zvandiri culture is that every team member has something valuable to contribute. This is embedded in our leadership then cascaded to all staff doing their utmost to recognise everyone’s efforts. Our moto is ‘with support we stand strong’ – we need each other to thrive. We nurture a sense of belonging in Zvandiri through a vibrant WhatsApp group for celebrating organisational successes, sharing key information and recognising people’s personal celebrations and losses. Decision-making processes are not determined by ‘rank’ but by the knowledge and experience required e.g staff from across Zvandiri jointly developed our 5 year strategic plan in June. We invest in people’s on-going growth – our Zvandiri Mentors support and nurture our teams across Zimbabwe; our monthly staff meetings engage all and rotate presenters from across the organisation. We are immensely proud that 45 (of 203) staff were once beneficiaries of Zvandiri. Our Board comprises two former beneficiaries who in turn support a Peer Advisory Board of ten young people living with HIV. We conduct an annual organisational capacity assessment and evaluate ourselves against 9 domains – one domain focuses on our systems and processes for joint planning and decision making, growth and development opportunities for our team.

Since 2004, my team and I have championed a holistic approach to improving the lives of children, adolescents and young people living with HIV. Whereas the HIV response has been dominated by a biomedical response, we have advocated at global, national and community level for services which recognise that young people need more than medicines. This obsessive, determined belief has been driven by 18 years of partnership with young people whom we have listened to, learned from and grown together with as we have evolved and scaled Zvandiri. This approach has been adopted by WHO and governments regionally.

We have ensured that young people living with HIV remain at the forefront of Zvandiri's leadership, design, implementation, monitoring and evalI amuation. Our constitution requires that two Board members are you representatives. They in turn support a Peer Advisory Board comprising young people elected by their peers across the Zvandiri programme. New projects are designed in partnership with Zvandiri youth and services are primarily led by young people living with HIV as CATS and Young Mentor Mothers. Zvandiri youth are actively engaged in our research and we have recently been awarded a prize in recognition of this work. (see video link below).

Zvandiri's journey has been one of perseverance! The global HIV response has been dominated by a biomedical response which measures numbers tested, numbers on treatment and numbers who are virally suppressed. This ignores the reality of people's lives. Zvandiri is founded in the belief that CAYPLHIV need more than medicines - they need services which address their well-being and mental health. If we get that right, both their health and quality of life will improve. Further, we have passionately believed that young people are the solution. 

Since 2004, I have advocated for the critical role of youth-led psychosocial support and mental health within the HIV response. Below are two examples of success:

1) I ensured funding and partnerships with world-renowned researchers to conduct two randomised controlled trials - The Zvandiri Trial and The Zvandiri-Friendship Bench Trial (results in press) - to generate empirical evidence of Zvandiri's impact on viral suppression and mental health.

2) In 2020, I led a global consultation with young people living with HIV on behalf of WHO which directly informed its new guideline, strongly recommending psychosocial support and mental health interventions for all adolescents with HIV, and these should be led by peers. WHO Guidelines 2021

In 2015, I featured in a documentary produced by The Elton John AIDS Foundation about the work of Zvandiri - (1 minute 40 secs)

Zvandiri and the Elton John AIDS Foundation

In 2019, I delivered a TEDx Talk in Harare, Zimbabwe - 'Accept Me As I am' describes the Zvandiri journey, demonstrating the pills alone are not enough.

TEDx - Zvandiri, Accept Me As I Am

I have also presented in a number of webinars through which I have spoken on the work of Zvandiri. Two recent examples are here below:

More than Medicine (2021)- We were awarded a prize from The Coalition for Children Affected by AIDS and Viiv Healthcare for our work on supporting children and adolescents living with HIV (12 minutes, 5 secs)

Reaching All Children Webinar

Young People, Some Paints and a Camera (2021) - We were awarded a prize from AHISA for our work on engaging youth in HIV research (26 minutes, 50 secs)

AHISA Prize - Adolescent Engagement in HIV Research

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We are at a critical point in our journey of growth and scale. We have a proven model which is in demand across the region with new countries seeking technical assistance from Zvandiri. We have developed a standardised programme of on-site and digital technical assistance for these countries. The Elevate Prize Funding will provide much-needed funds and partnerships to:

1) Design, deliver and scale an online digital training and mentorship programme for Governments, Health Care Workers, Implementers and CATS to expand their capacity to provide quality services for CAYPLHIV. This will be developed in partnership with the World Health Organisation and Zimbabwe's Ministry of Health and Child Care. 

2) Develop an interactive digital app for CATS in Zvandiri-supported countries across Africa to support them in providing services to the children and adolescents in their care. We have piloted this approach with a CATS app we designed and know this to be a feasible, effective, much needed strategy which CATS need and want. But our current app is well below what is required for regional scale up.

3) Hire core technical staff to deliver technical assistance to new countries partnering with Zvandiri, including former Zvandiri beneficiaries hired as expert trainers. 

We have the privilege of working with a variety of institutions, technical and funding partners including:

1) Governments - we ensure sustainable scale up of Zvandiri through partnering with governments to implement Zvandiri. 

2) The World Health Organization (WHO) - we support WHO in the development and dissemination of policies and guidelines to strengthen service delivery for CAYPLHIV. 

3) Research Institutions - we are not researchers but are deeply committed to the development of empirical evidence to inform Zvandiri’s continued growth. We partner with world renowned academics to ensure robust research and evidence. 

4) PEPFAR - As our main funding partner, we have been collaborating with PEPFAR through USAID and CDC since 2015 when PEPFAR declared Zvandiri a ‘Game Changer’ for children and adolescents living with HIV. 

5) Global Fund - Global Fund has taken up Zvandiri in Zimbabwe, supporting the Ministry of Health and Child Care to directly implement Zvandiri. We are providing technical assistance to this programme. 

6) National AIDS Council (NAC) - Zimbabwe's NAC has taken up direct funding for Zvandiri using domestic resources. To our knowledge, this is the first country to directly fund an adolescent-led, HIV and mental health response for children and adolescents.