Scaling up peer‐led community‐based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success

Abstract

Introduction Low rates of viral suppression among adolescents living with HIV (ALHIV) indicate that more effective support is urgently required at scale. The provision of peer support has generated considerable enthusiasm because it has the potential to ameliorate the complex social and relational challenges which underpin suboptimal adherence. Little is known about the impact on young peer supporters themselves, which is the focus of this paper. Methods We present qualitative findings from the Zvandiri trial investigating the impact of a peer support intervention on the viral load for beneficiaries (ALHIV, aged 13 to 19 years) in Zimbabwe. The Zvandiri peer supporters aged 18 to 24 years, known as community adolescent treatment supporters (CATS), are themselves living with HIV. Individual in‐depth interviews were conducted in late 2018 with 17 CATS exploring their experiences of delivering peer support and their own support needs. Interviews were analysed iteratively using thematic analysis. Results The CATS reported that being peer supporters improved their own adherence behaviour and contributed to an improved sense of self‐worth. The social connections between the CATS were a source of comfort and enabled them to develop skills to manage the challenging aspects of their work. Two substantial challenges were identified. First, their work may reveal their HIV status. Second, managing the emotional labour of this caring work; given how commonly the complexity of the beneficiaries’ needs mirrored the circumstances of their own difficult lives. Both challenges were ameliorated by the support the CATS provided to each other and ongoing supervision from the adult mentor. There was variation in whether they felt their roles were appropriately valued through the remuneration they received and within the health system. There was a consensus that their experience meant that they would graduate from being a CATS with transferable skills that could enhance their employability. Conclusions Their experiences illustrate the advantages and opportunities of being a CATS. To minimize potential harms, it is vital to ensure that they feel valued in their role, which can be demonstrated by the provision of appropriate remuneration, recognition and respect, and that there is continued investment in ongoing support through ongoing training and mentoring.

It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV

“…Organizations that utilize young peer supporters have an ethical responsibility to support and protect these young people, whom are living with HIV themselves and may be affected by the pressures inherent in the peer supporter role [22]. This study builds on previous research that identified emotional risk to peer supporters and the pivotal role played by their mentors [20]. This need for support increases further when the role of the peer supporter expands to include mental health, which engages them more deeply in their own difficult experiences as well as their feelings of responsibility for alleviating the pain of others [31].…”

“…A recent trial of the Zvandiri peer support model, which uses differentiated service delivery, showed an increase of viral load suppression among ALHIV of 42% compared to standard care [ 19 ]. Despite enthusiasm and donor funding for peer support, its impact on beneficiaries and on the peer supporters themselves has received relatively little empirical attention [ 20 – 22 ]. Also, to date peer support among ALHIV has focused primarily on prevention and general psychosocial support and has not delved into addressing more complex issues associated with common mental health disorders.…”

Thetha Nami : Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

“…The DOART trial showed that community-based care was superior to facility-based HIV treatment in supressing HIV viral load [10]. Community-based approaches -particularly when integrated with psychosocial care -can foster social networks, mobilise HIV competent communities and stimulate progress towards the sustainable development goals [11][12][13][14][15][16][17]. This is particularly important for adolescents [18].…”

“…This is particularly important for adolescents [18]. This was shown in a peerled intervention for adolescents living with HIV in Zimbabwe, the rst study to improve adolescent HIV viral suppression [12,19,20].…”

Untitled

“…A recent trial of the Zvandiri peer support model, which uses differentiated service delivery, showed an increase of viral load suppression among ALHIV of 42% compared to standard care [19]. Despite enthusiasm and donor funding for peer support, its impact on beneficiaries and on the peer supporters themselves has received relatively little empirical attention [20][21][22]. Also, to date peer support among ALHIV has focused primarily on prevention and general psychosocial support and has not delved into addressing more complex issues associated with common mental health disorders.…”