Community Based Interventions to Improve HIV Outcomes in Youth: a Cluster Randomised Trial in Zimbabwe
Condition: HIV Infection
MeSH terms: HIV Infections
Study type: Interventional

Summary: 
      A cluster randomised trial to determine the impact of an integrated community-based package
      of HIV services incorporating HIV testing, linkage to care and ongoing adherence support,
      combined with sexual and reproductive health (SRH) services and general health counselling
      for 16 to 24 year olds on population level HIV viral load in a high HIV prevalence setting.
    

Detailed description: 
      Young people fare disproportionately poorly across the HIV care continuum compared to other
      age-groups; the prevalence of undiagnosed HIV is substantially higher, and coverage of and
      adherence to antiretroviral therapy is lower, resulting overall in worse virological
      outcomes.

      Aim: The aim is to determine the impact of an integrated community-based package of HIV
      services incorporating HIV testing, linkage to care and ongoing adherence support, combined
      with sexual and reproductive health services and general health counselling for 16 to 24 year
      olds on population level HIV viral load in a high HIV prevalence setting.

      Design: This is a two-arm cluster-randomised trial in 24 clusters randomised 1:1 to standard
      of care or to the intervention package.

      Intervention: Community-based package of services that includes: HIV testing and counselling,
      delivery of antiretroviral therapy, adherence support groups, mobile health, condoms,
      menstrual hygiene management, contraception and treatment of sexually transmitted infections,
      referral for voluntary medical male circumcision and cervical screening, risk reduction
      counselling and general health information and counselling. The intervention will be
      implemented over a two and half year period. The intervention will be implemented in 12
      clusters, each with a population of approximately 2500-4000 16-24 year olds.

      Study Outcomes: The study outcomes will be determined at a population level through a
      community cross-sectional survey among 18 to 24 year olds two years following the
      implementation of the intervention. The primary outcome is the proportion with HIV with a
      viral load <1000 copies/ml. The secondary outcomes will reflect each step of the HIV care
      cascade: proportion with HIV who know their HIV status, proportion of those who know their
      HIV-positive status who are currently taking antiretroviral therapy, proportion of those
      taking antiretroviral therapy who are virally suppressed. Sexual and reproductive health
      knowledge, risks and behaviour will also be assessed.

      Study population: The end-line survey will recruit 700 18-24 year olds per cluster (total 16
      800).

      Study sites: The study will be conducted in 3 provinces in Zimbabwe: Harare, Bulawayo and
      Mashonaland East.

      Study Duration: The planned duration of the entire study will be 4 years
    

Intervention name(s): Community-based package of integrated HIV, SRH and general health services
Intervention type(s): Other
Intervention description(s): HIV Testing and Counselling, SRH and HIV prevention Services and General Health Counselling for all 16-24 year olds and ART initiation and ongoing treatment and adherence support for those who test HIV positive
Other intervention name(s): Cluster-randomized trial
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Community Based Interventions to improve HIV outcomes in youth: a cluster randomised trial
Masking: Single (Outcomes Assessor)
Primary purpose: Other
Keywords: Adolescents; Youth; Sexual and reproductive health; Africa; community-based