Integrating competency-based assessment into training with peer counsellors providing support at scale to children, adolescents and young adults living with HIV in Zimbabwe: An implementation pilot case study

Zvandiri is a differentiated psychosocial support program delivering peer-counselling to children, adolescents and young adults living with HIV (CAYALHIV), functioning at a national scale in Zimbabwe and in 14 other African countries. Stigma and mental health issues are significant drivers of suboptimal health outcomes in CAYALHIV, particularly in low-resource settings where the professional workforce is inadequate to meet the volume of need. Task shifting to peer counsellors has shown promise in improving care yet developing robust mechanisms to ensure consistent quality has received limited attention to date. To promote quality services delivered by peer counsellors (ages 18 - 24 years), Zvandiri sought to pragmatically address the feasibility and effectiveness of integrating the World Health Organization's EQUIP (Ensuring Quality in Psychological Support) competency-based assessment into a standard peer-counsellor training. Sixteen CATS, ages 19 - 22 years (M8:F8), already working as Zvandiri peer-counsellors, were identified by their supervisors as needing skills strengthening and selected to participate in the standard five-day CATS training. Additional days were added for baseline and endline competency assessments. This pilot integrating EQUIP's competency-based approach into the CATS training effectively identified gaps in counselling skills at baseline, enabling trainers to target these competencies throughout the training. The endline assessment demonstrated that all 16 participants developed stronger counselling skills. A follow-up open-text self-assessment was conducted seven months post-training with both participants and supervisors. There was consistency in the reporting of increased confidence and improved client interactions, with changes attributed to the enhanced counselling skills learnt in the training. Based on these findings, Zvandiri will integrate EQUIP assessments into the initial training provided to peer-counsellors when they first join Zvandiri and within the CATS' regular group supervision, in a targeted way to support the identification of further skills strengthening required to maintain quality delivery of counselling services at scale by peer-counsellors.