Nicola Willis

Nicola has transformed the healthcare system for young people in Zimbabwe and is now looking to do the same across SubSaharan Africa by training young people as peer counselors embedded within public health systems. Through her organization Zvandiri, she trains these young people to deliver holistic, youth-led support that addresses both medical and psychosocial needs, and institutionalises these approaches through national policy, digital innovation, and government partnerships, introducing a systems changing approach to healthcare.

Nicola’s work fundamentally reframes the role of young people living with HIV, positioning them not as passive recipients of care but as empowered leaders and essential contributors within the very systems that shape their lives. By embedding youth as peer leaders and counselors within public health systems, her approach challenges deep-seated assumptions about the capabilities of young people and disrupts traditional, hierarchical models of healthcare delivery. This shift is particularly powerful in contexts where stigma and exclusion have long defined the experience of living with HIV, especially for children and adolescents. Nicola’s model recognizes the agency, resilience, and insight of young people, transforming them into trusted partners and change agents who are central to both the care process and the evolution of the system itself.



At the heart of this approach is a holistic, peer-led model that addresses not only medical adherence but also the psychosocial, mental health, life skills and broader health needs of young people living with HIV. Through Zvandiri, youth are trained as Community Adolescent Treatment Supporters (CATS) and Young Mentor Mothers (YMMs), providing a safe, empathetic environment where peers can openly discuss the realities of living with HIV, confront stigma, and navigate the challenges of disclosure and self-acceptance. Unlike conventional, clinic-based interventions that focus narrowly on biomedical outcomes, this peer-to-peer support system recognizes the complex, multifaceted nature of well-being. It creates spaces where youth can build trust, share experiences, and develop the skills necessary to thrive—not just survive—in the face of chronic illness and social marginalization.



What sets this idea apart is its systemic integration into public health systems and its influence on national policy. Rather than operating as a parallel NGO initiative, Zvandiri works hand-in-hand with government ministries, embedding peer counselors directly within clinics and hospitals. This collaboration has led to the inclusion of peer-led approaches in professional training curricula, the adoption of youth-friendly practices by health workers, and the institutionalization of the peer-provider model in government policy. The model is further strengthened by digital innovations such as the Zvandiri Connect application, which enables real-time case management, counselling and screening, data collection, and rapid response, ensuring that care is coordinated, accountable, and evidence driven. These elements combine to create a model that bridges the gap between clinics and communities, shifting attitudes and practices at every level of the system.



The codification of this approach through the Thrive95 framework marks a pivotal step in scaling and sustaining its impact. Developed in partnership with national and international bodies, Thrive95 distills the core elements of the peer-provider model into a set of pillars—including leadership, financing, supervision, and digital monitoring—that can be adopted by governments across diverse contexts. By moving beyond organizational branding and focusing on systems change, Nicola enables national ownership and long-term sustainability. The model’s effectiveness is underpinned by robust evidence, including randomized trials and national data demonstrating significant improvements in viral suppression, mental health, and broader health and social outcomes for youth. Through this combination of systemic integration, peer leadership, digital innovation, and evidence-based advocacy, Nicola’s idea is setting new standards for youth-centered HIV care and catalyzing a shift in how societies address chronic health challenges among their most vulnerable members.

Across sub-Saharan Africa, the HIV epidemic continues to cast a long shadow over the lives of millions of young people. An estimated 2.4 million children and adolescents are living with HIV globally, with more than 85% residing in this region. Despite decades of scientific advances and the widespread availability of antiretroviral therapy (ART), only about half of these young people receive the life-saving treatment they need. Even more concerning, access to essential mental health and psychosocial support remains a rarity, leaving the majority to navigate the complexities of chronic illness in isolation. The result is a persistent crisis: poor treatment adherence, high rates of depression and anxiety, and a cycle of illness and exclusion that continues to undermine the potential of an entire generation.

While adults in many parts of the world have seen dramatic improvements in HIV outcomes, children and adolescents in sub-Saharan Africa remain disproportionately affected. In countries like Zimbabwe, where over 160,000 young people live with HIV, the challenges are compounded by under-resourced healthcare systems, chronic shortages of trained professionals, and persistent cultural stigma. International efforts have acknowledged the unique vulnerabilities of this group, but responses are often fragmented and overwhelmingly focused on biomedical interventions, neglecting the holistic, youth-centered care that is so urgently needed.

At the heart of the problem lies a critical disconnect: the issue is not simply whether ART is available, but whether young people are able to take it consistently. The drugs themselves are highly effective when taken as prescribed, yet many children and adolescents struggle with adherence. This difficulty is rooted in a web of complex psychosocial and mental health challenges—depression, anxiety, trauma, grief, and a pervasive sense of isolation—that are rarely addressed by current healthcare models. For many, the daily burden of treatment is a constant reminder of their status, compounding feelings of shame and difference. Without adequate mental health and psychosocial support, these barriers become insurmountable, resulting in low rates of viral suppression and ongoing risk of illness and transmission.

Cultural stigma and discrimination further entrench the problem, shaping every aspect of young people's experience with HIV. In many communities, HIV is still associated with moral failing, contagion, and shame. Children and adolescents face bullying and exclusion at school, are shunned in their communities, and often encounter silence or secrecy even within their own families. The fear of being ostracized discourages disclosure and help-seeking, driving young people into deeper isolation and psychological distress. This stigma is particularly acute for those who are orphaned, members of marginalized groups, or dealing with additional layers of vulnerability, such as young mothers or LGBTQIA youth.

Systemic and economic barriers compound these challenges, making it even harder for families to access the support they need. Widespread poverty limits access to transportation and education— which are essential for adhering to treatment and engagement in services. Healthcare infrastructure is often inadequate, with clinics lacking both the resources and the trained personnel required to deliver integrated, youth-friendly care. Traditional, paper-based health information systems make effective case management and monitoring difficult, further fragmenting services and undermining continuity of care.

A critical but often overlooked dimension of the problem is the exclusion of young people themselves from the design and delivery of healthcare services. Too often, children and adolescents living with HIV are treated as passive recipients rather than active participants in their own care. This lack of agency reinforces models that fail to address the complex interplay between physical health, mental well-being, and social realities. As a result, existing systems are ill-equipped to respond to the true needs of young people, perpetuating cycles of poor health and disempowerment.

The cumulative impact of these failures is profound and far-reaching. Studies show that ART adherence and viral suppression rates for adolescents in sub-Saharan Africa lag far behind those of adults, with only 65% adhering to treatment and just 55% achieving viral suppression. Mental health disorders are alarmingly common, with nearly a quarter of young people living with HIV experiencing depression, and up to 30% reporting suicidal ideation at some point in their lives. These challenges are closely linked to stigma, social exclusion, and the absence of meaningful psychosocial support. The consequences extend beyond health, limiting educational attainment, economic opportunity, and social participation, and ensuring that the burden of HIV—and the stigma that surrounds it—will persist across generations unless these systemic gaps are addressed.

The primary beneficiaries of Nicola’s work through Zvandiri are children, adolescents, and young adults aged 0 to 24 living with HIV, primarily in Zimbabwe but increasingly in other African countries. In Zimbabwe alone, over 160,000 young people fall into this group, with millions more across sub-Saharan Africa.



A second, closely related group consists of young people living with HIV who are recruited, trained, and supported to become Community Adolescent Treatment Supporters (CATS) and Young Mentor Mothers (YMMs). Numbering in the thousands, these peer counselors are drawn from the very communities they serve, ensuring cultural relevance and deep empathy. They face their own challenges—navigating their HIV status, overcoming internalized stigma, and building confidence—but through Zvandiri, they are transformed into leaders, role models and lay health providers. Their responsibilities include bridging the gap between clinics and communities, providing peer-led counseling, supporting adherence, and facilitating safe spaces for disclosure and psychosocial support. They also provide information, counselling and screening for HIV testing, mental health, Tuberculosis, and young people’s sexual and reproductive health. By empowering these young people, Zvandiri not only improves their own life trajectories but also shifts societal perceptions about youth living with HIV, demonstrating their capacity to lead and inspire.



The third group comprises healthcare workers, clinic staff, government officials, and policymakers within the national health system, particularly in Zimbabwe but also in other countries adopting the Zvandiri model. While not direct recipients of care, these stakeholders are crucial beneficiaries of Zvandiri’s systemic impact. They grapple with overburdened clinics, limited resources, and a lack of youth-friendly services. By integrating peer counselors into their teams, these stakeholders gain access to innovative, clinic and community-based approaches that improve health outcomes, reduce clinic workloads, and foster more inclusive and responsive care environments. As supervisors for the peer providers, their engagement is essential for the sustainability and scalability of the model, as their buy-in and capacity-building are necessary for embedding peer-led approaches within institutional frameworks and ensuring long-term systemic change.



Zvandiri’s core innovation is its peer-led, holistic approach to HIV care and mental health support for young people. The opportunity arises from the failure of traditional, clinic-based models to address the complex, intersecting needs of children and adolescents living with HIV. Recognizing that stigma, mental health, and social determinants are as critical as medical treatment, Zvandiri trains young people living with HIV as CATS and YMMs, equipping them with skills in counseling, psychosocial support, and health education. The selection process is rigorous, seeking individuals who not only live with HIV but also demonstrate a commitment to supporting their peers and serve as positive role models. The initial training lasts for 5 days, but once they become peer mentors, there is ongoing training to ensure their continuous development and capacity building. Training is delivered in partnership with the Ministry of Health and combines storytelling, therapeutic exercises, foundational counseling skills based on cognitive behavioural therapy, empathy, active listening, and reflective practice. Through this process, peer counselors are equipped to provide services through clinics, home visits, group sessions, and digital platforms - becoming trusted confidantes and advocates for their peers and ensuring that care is accessible, comprehensive, and tailored to individual needs. The model is grounded in values of empowerment, empathy, and inclusivity, activating young people as changemakers who drive improvements in their communities and the broader health system. To date, Zvandiri has supported Governments to train over 7600 peer counsellors in the region and supported over 280 000 children and young people living with HIV.



Impact is already evident: studies show reductions in treatment failure, lower mortality, and improved mental health outcomes among participants. The model achieves direct impact by providing individualized support, indirect impact by influencing families and communities through empowered youth, and systemic impact by shifting the role of young people within healthcare.



A concrete example is the integration of CATS into public health clinics in Zimbabwe. Here, a young person living with HIV, trained as a CATS, facilitates support groups, conducts home visits for peers who miss appointments, and provides counseling and support for treatment adherence as well as the broader health needs and challenges young people face. This direct engagement creates a safe space for disclosure and fosters hope, trust and self-acceptance, leading to higher rates of viral suppression and improved mental health. Systemically, this approach challenges the prevailing mindset that youth are passive recipients of care, instead positioning them as essential contributors to health outcomes. The model’s success has influenced national policy, with the Ministry of Health adopting peer-led approaches as a standard of care, embedding youth empowerment and holistic support into the fabric of the healthcare system.



A key programmatic innovation is the formal integration of peer counselors into national health systems. The opportunity here is to move beyond parallel, donor-funded initiatives and embed youth leadership within the public sector. Zvandiri partners with the Zimbabwean Ministry of Health and Child Care to embed CATS and YMMs within government clinics and community health teams. Peer counselors work alongside healthcare professionals, supporting their respective caseloads, tracing patients who have missed appointments, providing adherence and psychosocial counseling, and facilitating referrals to specialized services such as mental health, TB or sexual and reproductive health care. This model builds the capacity of the public health system to deliver differentiated, holistic care and ensures that the peer-led approach is not a temporary intervention but a permanent feature of health service delivery. The impact is direct—through improved outcomes for young people—and systemic, as the model transforms institutional practices and professional norms.



For example, in over 50 district clinics across Zimbabwe, CATS are now part of the official healthcare team, participating in case management meetings and contributing to patient care plans. Their presence has led to increased retention in care and reduced loss to follow-up among adolescents. This integration changes the social system by redefining the roles of young people within healthcare, fostering mutual respect between youth and adult professionals, and institutionalizing peer-led support as a best practice. Over time, this has led to changes in training curricula for health workerse, the development of youth-friendly policies, and the allocation of government resources to sustain peer-led services, embedding the approach within the national health infrastructure.



To enhance efficiency and scalability, Zvandiri developed Zvandiri Connect, a digital tool that enables peer counselors to conduct electronic case management and real-time data collection. The opportunity here is to overcome the limitations of traditional paper-based systems, which are often slow, fragmented, and prone to error. Zvandiri Connect allows for integration of youth-friendly job aides and counselling tools with immediate tracking of client contacts, services provided, and referrals made, improving coordination and responsiveness. Supervisors can access real-time dashboards to monitor program performance and client outcomes, supporting evidence-based decision-making and quality assurance. This innovation supports direct impact by improving individual client monitoring, indirect impact by enabling better supervision and resource allocation, and systemic impact by strengthening the data infrastructure of the health system.



A concrete example is the use of Zvandiri Connect in a district with high rates of adolescent HIV. CATS use the app to log each client interaction, flagging cases that require urgent follow-up or referral. Supervisors can identify trends and allocate resources more effectively, leading to improved treatment adherence and health outcomes. A new supervision tool is being integrated to support standardized, systematic supervision for CATS by health care workers. This digital transformation shifts mindsets among health workers and policymakers, who increasingly see technology as an enabler of integrated, community-based care. It also sets new standards for data-driven program management, influencing other health programs and ministries to adopt similar innovations. Over time, Zvandiri Connect’s integration into national systems supports the scale-up of the peer-led model by providing the tools needed for quality assurance, accountability, and continuous improvement.



A defining feature of Zvandiri’s strategy is its commitment to scientific validation and rigorous evaluation. Recognizing the skepticism of policymakers and global health leaders toward peer-led approaches, Nicola and her team undertook a randomized controlled trial in 2018, in partnership with research organizations, to empirically assess the impact of the Zvandiri model. The results were compelling: participants in the Zvandiri program demonstrated significantly higher rates of viral suppression and reduced mortality compared to control groups. A second randomized controlled trial in 2020 found a 60% reduction in symptoms of depression and anxiety. These findings provided the empirical evidence needed to influence national and global guidelines, with organizations such as WHO and UNICEF citing Zvandiri as a best practice for youth-centered HIV care. Ongoing research and data collection continue to inform program improvements and advocacy efforts, ensuring the model remains evidence-based and responsive to emerging needs.



Zvandiri’s primary scaling strategy is the Thrive95 framework, developed in partnership with Zimbabwe’s Ministry of Health, WHO, and UNICEF. Thrive95 institutionalizes the peer-provider model by embedding it into national health systems through eight interlocking pillars: leadership, domestic financing, supervision, digital monitoring, policy integration, professional training, community engagement, and quality assurance. The opportunity here is to move from successful pilot projects to government-owned, nationally funded systems. Thrive95 ensures that peer counselors are included in national service delivery guidelines, domestic budgets, and digital monitoring systems like ZVAMODA. By embedding these elements into the core of the health system, Thrive95 drives systemic change—shifting mindsets among policymakers and providers, normalizing youth leadership in healthcare, and setting new global standards for youth-centered HIV care. The framework’s adaptability enables replication in other countries, making it a blueprint for global scale.



The international spread of the Zvandiri approach is rooted in a technical assistance model that prioritizes government leadership and local adaptation. Zvandiri provides training, mentorship, and ongoing support to ministries of health and local partners in 15 countries across sub-Saharan Africa. The model is tailored to each context, with implementation plans developed in partnership with government stakeholders to ensure relevance and sustainability. In some countries, Zvandiri seconds staff to work directly within ministries, building internal capacity and supporting the establishment of peer-led programs. This approach has enabled rapid replication while maintaining fidelity to the core principles of youth empowerment, holistic care, and system integration.



Nicola actively promotes the global adaptation and replication of the Zvandiri model through knowledge sharing, technical assistance, and partnerships with international organizations. The venture documents best practices, develops toolkits, and provides training to other countries seeking to adopt peer-led, holistic HIV care. By participating in global forums and collaborating with agencies like WHO and UNICEF, Zvandiri influences international norms and standards, encouraging the uptake of youth-centered approaches worldwide. This strategy leverages the growing recognition of adolescent health and the need for differentiated care, embedding the peer-provider approach in global health systems, and setting a precedent for other health challenges. As more countries adopt and adapt the Zvandiri model, the systemic impact grows, shifting mindsets about the role of young people in healthcare and establishing new standards for youth engagement and leadership.



Zvandiri’s peer-led, holistic approach has resulted in measurable improvements in both health and psychosocial outcomes for young people living with HIV. By creating safe, non-judgmental spaces for disclosure and support, amid shifting perceptions of what it means to be a young person living with HIV, the program has reduced HIV-related stigma and social isolation, leading to better treatment adherence and viral suppression. The integration of mental health support into HIV care has addressed a critical gap, through promoting good mental health and well-being as well as systematic screening and referral for psychiatric disorders now part of routine care.



The model’s success has influenced national policy and professional training curricula, with peer-led approaches now recognized and institutionalized within Zimbabwe’s public health system. Key outcomes include:



● Reduced treatment failure rates by up to 40% among young people living with HIV in program areas, as measured by viral load suppression data.

● Decreased mortality rates among adolescent clients by 30% compared to standard care, according to longitudinal program monitoring.

● Reduced symptoms of depression and anxiety among 60% of clients screened, as measured by validated mental health screening tools.

● Increased ART adherence rates to over 90% among clients engaged with CATS, as tracked through ZVAMODA and clinical records.



● Institutionalized peer-led HIV care within national health guidelines and professional training curricula, impacting the standard of care for all young people living with HIV in Zimbabwe.



● Zvandiri Cost Effectiveness Study (2025): This found Zvandiri to be highly cost effective, yielding a discounted ICER of $372 per LY gained and $99 per QALY. Furthermore, A recent economic assessment of the Zvandiri in Zimbabwe by CHAI found that scaling it nationally from 2025 to 2035 would cost US$21.6 million but generate US$24.4 million in net financial benefit, driven by an estimated US$31.7 million in averted treatment costs and US$14.3 million in averted testing costs.





Looking to the future, Zvandiri’s vision is to further deepen the integration of peer-led, holistic support models within public health infrastructure across Africa and globally. The organization aims to expand the reach of the Thrive95 framework, supporting more countries to adopt, adapt, and institutionalize youth-centered HIV care as a standard practice. Plans include formalizing a network of countries for annual review and knowledge exchange, continuing to build evidence through research and data collection, and advocating for the global standardization and financing of peer-led, holistic HIV care. By focusing on government ownership, robust digital systems, and international collaboration, Zvandiri is poised to catalyze a fundamental shift in how societies respond to adolescent HIV, setting a precedent for addressing other health challenges through similar youth-centered, system-integrated approaches.

Nicola’s journey began in England, where her childhood unfolded in a household that valued service and integrity. Early on, she was immersed in an environment shaped by her parents’ commitment to healthcare, which exposed her to conversations about equity and the realities of those who lacked access to medical support. Her education extended far beyond the classroom, as she threw herself into music, leading orchestras and competing on national stages, and embraced sports and travel, which introduced her to a wide array of cultures and perspectives. These formative experiences cultivated a curiosity about the world and a readiness to take initiative, which became evident when she was appointed Head Girl at her school—a role that demanded both leadership and the ability to unite others around a shared purpose. The combination of these pursuits—balancing rigorous academics with creative and collaborative endeavors—helped her develop the confidence to navigate unfamiliar situations and the resilience to persist in the face of setbacks, laying the groundwork for her future work at the intersection of health and social change.





Nicola’s connection to the challenges faced by young people living with HIV took root in her adolescence, when she witnessed the impact of AIDS on her uncle and the silence that surrounded his illness. This personal encounter with stigma and loss left a lasting impression, prompting her to seek out opportunities to support those on the margins of society. As a newly qualified nurse, she volunteered in a Romanian hospice for children with HIV, where she saw how small acts of care could transform moments of fear into comfort and hope. Later, working in London as a pediatric HIV nurse, she met young patients from Africa who navigated not only the complexities of their diagnosis but also the isolation that came with it. Through these experiences, Nicola observed the limits of clinical care in addressing the emotional and social burdens of HIV, and she recognized the importance of trust, shared experience, and open dialogue in helping young people manage the realities of lifelong treatment. Each encounter deepened her understanding of the problem—not just as a medical issue, but as a challenge rooted in stigma, secrecy, fear and the absence of youth voices in their own care.



The moment that propelled Nicola from understanding the problem to actively seeking solutions arrived during a volunteer trip to Ghana. Expecting to join a functioning clinic, she instead found an empty plot where a promised facility had not materialized due to funding shortfalls. Rather than accepting defeat, she rolled up her sleeves and worked with local leaders and community members to build the clinic from the ground up, navigating unfamiliar customs and resource constraints along the way. This experience revealed to her the transformative potential of community-driven action and the importance of listening to those most affected by a problem. The success of the clinic and the systems established for HIV prevention became a catalyst, inspiring her to continue her journey in Zimbabwe, where she founded Zvandiri. There, she set out to reimagine HIV care by placing young people at the center—as peer counselors, mentors, and leaders—so that those living with HIV could shape their own futures and support one another in ways that traditional healthcare systems had overlooked. Nicola has embedded her life in Zimbabwe for over 20 years and continues to raise her family there.