Supporters CATS in Index Case Testing in Zimbabwe Patience Mushamiri Community Adolescent Treatment Supporter CATS Africaid Zvandiri IAS Amsterdam Netherlands July 23 2018 A local registered ID: 928889
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The Role of Community Adolescent Treatment Supporters (CATS) in Index Case Testing in Zimbabwe
Patience MushamiriCommunity Adolescent Treatment Supporter (CATS), Africaid ZvandiriIAS – Amsterdam, NetherlandsJuly 23, 2018
Slide2A local, registered private voluntary organization in ZimbabweEstablished in 2004 in response to a request for a support group by six adolescents living with HIVThey named the group ‘Zvandiri’, meaning “As I am”
Initially led by volunteers, the goal was to support the government with the integration of psychosocial support within pediatric and adolescent HIV treatment and careAfricaid2
Slide3Africaid is now implementing the Zvandiri Model in 51 of the 63 districts of Zimbabwe (though not covering all health facilities within the select districts)Supported Zvandiri activities includeHIV testing
services (HTS)ART initiation and adherenceRetentionSocial protectionSexual and reproductive health (SRH)Mental HealthDisabilityTBAdherence support to young mothers with HIV-exposed babiesSupport to differentiated service delivery Africaid Overview
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Slide4Ministry care model for children, adolescents, young people - primarily implemented by Community Adolescent Treatment Supporters (CATS)Zvandiri Programme Scale-Up
4CATS are:HIV-positive, 18-24 year oldsTrained and accredited as peer counsellors by Ministry of Health and Child Care (MOHCC), and AfricaidMentored and supervised by MOHCC Department of Social Welfare and Africaid1,200 CATS integrated in 51 districts and their surrounding communities120 CATS supported through the EGPAF’s Children’s Investment Fund Foundation (CIFF)- funded Adolescent Care and Treatment (ACT) ProjectInformation and counselling (HTS, disclosure, ART initiation and adherence, psychosocial support [PSS], and SRH)Linkage to internal and external servicesInformation and counselling for caregivers and partners
Participation in case conferences
Facilitation of adolescent corners
Co-facilitation of support groups, facility-based refill groups, young mothers groups
Follow-up
Referral
Identification
Improved
Uptake of HTS
ART initiation and adherence
Retention
Viral suppression
Mental health
Linkage to other services (
e.g
social protection, disability, mental health)
Index case finding for HTS
Information and counselling (as above)
Identification of red flags, referral for services and follow up
Tracing loss to follow up
SMS and WhatsApp clinic and adherence reminders and check ins
Co-facilitation of community adherence refills groups
CATS services within communities
Slide5ACT Adolescent Project Sites (EGPAF & Africaid) 5
Slide6Services are differentiated to standard and enhanced levels of support, according to the clinical and psychosocial needs of individual children, adolescents and young people CATS Across 90-90-90 Cascade
6Training and mentorship for health care workers (HCWs), social welfare officers, teachers and caregiversLinkage and bi-directional referrals with clinics, social workers, teachers, communities and families
Slide7Standard Support
Enhanced SupportUndetectable viral load - last 6 monthsRetention in care - last 3 months Psychologically stable
Safe
Detectable viral load in the last 6 months
Self report of
non-adherence
Commencing ART < 3 months
Opportunistic infection
Loss to follow-up (LTFU)
> 3 months
Psychological distress
Abuse, neglect
Pregnancy
MOHCC
treatment and care
CATS-led:
Twice-weekly home visit
Weekly SMS reminder
Clinic-based
counselling
Referrals and
linkages
CATS-Supported:
Monthly
support groups
Caregiver workshop
MOHCC
treatment and care
CATS-led:
Twice-weekly home visit
Weekly SMS reminder
Clinic-based counselling
–
content
Referrals and linkages
–
extra
support services (i.e. social protection, ANC etc.)CATS-Supported:Monthly support groupsCaregiver workshopAdherence workshopCase management with CHWs/CCCWs
CATS Levels of Support
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Slide8CATS Levels of Support 8Use of bicycles by CATS
Improved mobilityIncreased geographic coverageMobilization of index cases for HIV testingFollow-up on adolescents referred for HTSTracking and tracing of defaulters
Slide9OI/ARTFamily and Child Health Home visitsSupport groupsTargeted outreaches
Index Case Testing Process 9
Slide10Results at a Glance 10
Slide11Integration of CATS within the health facilitiesUnderstanding of their communities and contextual issuesStrong bi-directional linkages with other community cadres Peer-to-peer engagement with targeted beneficiaries
Use of bicycles to mobilize clients for HIV testingCritical Success Factors 11
Slide12Long distances to health facility for HIV testing Wrong addresses provided by contactsAdolescents are highly mobile Lack of disclosure by caregivers
Challenges 12
Slide13Thank you! Tatenda Siyabonga!
Contact: Patience Mushamiri – Email: info@zvandiri.org