Young people fare disproportionately poorly across the HIV care continuum compared to other age-groups; the prevalence of undiagnosed HIV is higher and coverage of and adherence to antiretroviral therapy is lower, resulting overall in worse HIV outcomes. Young people encounter many barriers to accessing health facilities. In addition, HIV is often not their top priority.
We aim to use an innovative approach to address these barriers:
Provision of services in community-based settings and configuration of services to create "youth appeal"
Integrated services: Providing HIV testing as well as treatment and adherence support; and integration with other services that youth need and want
The aim of the CHIEDZA Project is to investigate the impact of a community-based package of integrated HIV services and sexual and reproductive health services (SRH), and general health counselling, for youth on HIV and other health outcomes in a high HIV prevalence setting.
To measure the impact of a community-based intervention incorporation delivery of HIV (including HIV testing, treatment and adherence support) and SRH services and health counselling, for 16-24 year olds, on population-level HIV outcomes
To estimate the cost and cost-effectiveness of the intervention
To conduct a mixed-methods process evaluation of the intervention to inform scalability and sustainability
To estimate population-level prevalence of key health-related risk factors and behaviours in youth
We are conducting a cluster randomised trial in three provinces of Zimbabwe (Harare, Bulawayo and Mashonaland East). A total of 24 study clusters is randomised, in a 1:1 allocation ratio in each province, to:
1. Control Arm - Existing, routine services OR
2. Intervention Arm - A package of health services for16-24 year olds in community-based settings over two years
Cluster = geographically-defined area which has a community centre (where the services will be delivered) and a primary care clinic.
The outcomes will be determined through an end-line population-based survey of 24,000 youth (1000/cluster).
% of youth with HIV with a viral load < 1000 copies/ml
Secondary outcomes (corresponding to UNAIDS 90-90-90 targets)
% of youth with HIV aware of their status
% aware of their positive HIV status taking ART
% on ART with a viral load < 1000 copies/ml
Prevalence of health risk factors and behaviours
Process evaluation measures