The Zvandiri-ECHO Hub: Sustaining and strengthening case management of CAYPLHIV in the time of COVID
Zvandiri-ECHO Hub Case Management sessions are sustaining support and capacity building for frontline healthcare workers during COVID-19, enabling them to continue to provide quality, client-centred HIV testing, treatment and care services for children, adolescents and young people living with HIV.
COVID restrictions are preventing travel and physical interactions. However, the Zvandiri-ECHO Hub is ‘moving knowledge, not people’, conducting virtual Case Management sessions and ultimately ensuring continuity for paediatric and adolescent HIV care.
ECHO (Extension for Community Healthcare Outcomes) uses an evidence-based ‘Hub’ and ‘Spoke’ model. The Hub comprises a multi-disciplinary team of subject experts, including nurses, doctors and psychologists from Zvandiri and the Ministry of Health and Social Services. The Spokes are the frontline workers, for example, healthcare workers (HCWs), Zvandiri Mentors (ZMs) and Community Adolescents Treatment Supporters (CATS). Participants require very little technical equipment or bandwidth and join the Zoom sessions using a laptop or phone, enabling frontline workers in low resource and remote areas to share their experiences and access vital knowledge and support.
This approach is based on the sharing of real cases, followed by questions, discussion, recommendations and a didactic session, which enables peer-to-peer learning that is guided and facilitated by subject experts. Based on the principle of ‘all teach – all learn’, community healthcare providers learn from specialists, as well as from each other, and specialists learn from community healthcare providers. In this way, we create a ‘learning loop’ between those on the frontline of healthcare, and multi-disciplinary teams of experts working in paediatric and adolescent HIV.
With support from USAID, two Zvandiri-ECHO Hub Case management sessions have been conducted. The first focused on the management of high viral load in children and adolescents when the family is promoting use of traditional medicines. This session built the capacity of a multidisciplinary team of HCWs and ZMs in how to interpret and respond to a high viral load when family, religious and cultural factors contribute to treatment interruption. The session recommendations included the importance of supporting HIV and treatment literacy for the adolescent and their caregivers, and providing enhanced counselling, monitoring and support. The session also highlighted the critical need to work with faith communities, traditional and religious leaders in supporting HIV treatment.
The second session focused on mental health and ART adherence, sharing learning and building capacity among HCWs and ZMs to support ART adherence and mental health among children and adolescents living with HIV.
Other sessions are planned on a fortnightly basis to continuously equip frontline workers with the skills and confidence to manage complex cases without leaving their health facilities and communities – where their services are needed most. Zvandiri-ECHO Case Management sessions will ensure continuity and expert support, not only in the ‘new normal’ we face due to COVID-19, but beyond.