Abstract
IntroductionLow 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.MethodsWe 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.ResultsThe 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.ConclusionsTheir 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.
Highlights
Low rates of viral suppression among adolescents living with HIV (ALHIV) indicate that more effective support is urgently required at scale
The remit of the Community Adolescent Treatment Supporters (CATS) was to support other ALHIV, many of them themselves had been struggling with adhering to treatment: “Prior to being a CATS, I would take them anytime (ARVs)
Many reported that the training and education which they received through the programme had improved their treatment literacy and galvanised their commitment to compliance: “I only got to know about all of this when I became a CATS.” (Rudo, female, aged 24)
Summary
Low rates of viral suppression among adolescents living with HIV (ALHIV) indicate that more effective support is urgently required at scale. 95% of those on treatment to be virally suppressed, combined data from East and Southern African countries show that only 45% of adolescent girls living with HIV are virologically suppressed (versus the goal of 86% under UNAIDS 95-95-95 targets for 2030) [5]. This makes them more vulnerable to treatment failure. The provision of one-to-one peer support at scale has generated considerable enthusiasm because it has the potential to ameliorate the complex social and relational challenges that are known to affect adolescents’ capability to engage in sustained adherence to HIV treatment [6,7,8,9]. Being responsible for helping others experiencing the same problems may exacerbate the vulnerability of peer supporters
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
