Africaid, Harare, Zimbabwe.
Consultant, Zvandiri, London, United Kingdom.
J Acquir Immune Defic Syndr. 2018 Aug 15;78 Suppl 2:S115-S123. doi: 10.1097/QAI.0000000000001737.
Since 2004, there has been a dramatic shift in the HIV response for children, adolescents, and young people in low resource settings. Previous programs 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. Zvandiri is a theoretically grounded, multicomponent-differentiated service delivery model for children, adolescents, and young people in Zimbabwe that integrates peer-led, community interventions within government health services. Africaid analyzed routine program and other data from November 2004 to October 2017 to document Zvandiri scale-up, framed by the World Health Organization framework for scaling up interventions. 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 program within existing services, and capacity strengthening of service providers working jointly with trained, mentored CAYPLHIV. 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 program data contribute to the essential evidence base on strategic approaches to assist in planning services for this relatively neglected group.
自 2004 年以来，资源匮乏环境下的儿童、青少年和青年艾滋病毒应对工作发生了巨大转变。此前的项目和服务主要面向成年人。这种情况正在发生改变，但如何将儿童、青少年和青年艾滋病毒感染者（CAYPLHIV）的服务扩大规模，相关证据有限。Zvandiri 是一个理论基础扎实、多成分差异化的服务提供模式，适用于津巴布韦的儿童、青少年和青年，将同伴主导的社区干预措施与政府卫生服务相结合。Africaid 分析了 2004 年 11 月至 2017 年 10 月的常规项目和其他数据，以记录 Zvandiri 的扩展情况，并根据世界卫生组织扩大干预措施框架进行了框架。自 2004 年以来，Zvandiri 从哈拉雷的一个支持小组发展成为一个综合模式，结合了社区和诊所的卫生服务以及对 CAYPLHIV 的心理社会支持。Zvandiri 通过分阶段扩展到津巴布韦的 63 个区中的 51 个区，覆盖了 40213 名 CAYPLHIV。有证据表明，这种方法提高了艾滋病毒检测服务、治疗依从性和护理保留率的利用率。在将该模式扩大规模时，环境和战略选择至关重要，特别是将该方案嵌入现有服务中，并加强与经过培训和指导的 CAYPLHIV 共同工作的服务提供者的能力。这些结果为规划提供了坚实的基础，并为建立可持续影响的证据提供了依据。需要并正在进行正式的影响评估。这些项目数据为战略方法提供了重要的证据基础，有助于规划为这一相对被忽视的群体提供服务。
