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

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.