Uptake of community-based integrated HIV and sexual and reproductive health services for youth in Zimbabwe
Authors: Simms Victoria , Dauya Ethel , Chikwari Chido Dziva , Bandason Tsitsi , Kranzer Katharina , Tembo Mandikudza , Mavodza Constancia , Doyle Aoife M. , Larsson Leyla , Mugurungi Owen , Apollo Tsitsi , Hayes Richard J. , Ferrand Rashida A. 
Published: December 2024

Abstract

Introduction: Limited engagement with health services contributes to the poorer HIV care outcomes observed in youth. We conducted a cluster-randomised trial to investigate the impact of community-based integrated HIV and sexual and reproductive health (SRH) service (CHIEDZA) for youth on HIV outcomes in three provinces in Zimbabwe. Here we examine the uptake of services.
Methods: In the 12 intervention arm clusters, weekly integrated HIV and SRH services were delivered from community centres to cluster residents aged 16-24 years over 30 months. Service components included HIV testing, treatment and adherence support, management of sexually transmitted infections (STIs), menstrual health management, provision of condoms and contraception, counselling, and a tailored package of educational text messages on SRH topics. All components were optional. Fingerprint scanning was used to register clients and track their attendances and service uptake over time.
Results: In total 36,991 clients attended CHIEDZA services, for a total of 78,810 visits; each centre had a median of 55 clients per day; 40.6% of clients returned for more than one visit. Overall, 75.0% of clients were female and 53.0% were aged <20 years. Clients accessed a median 3 (IQR 2-4) service components/visit.
The most popular service components for women were menstrual health products (taken up at least once by 96.5% of eligible clients), HIV testing (83.7%) and period pain management (59.9%); for men the most popular were condoms (93.9%), HIV testing (85.6%) and text messages on SRH (67.1%). The most striking difference in component uptake by age was higher uptake of condoms (43.7%) and contraception (60.3%) in women aged ≥20 years.
In total 84.1% of eligible clients had at least one and 17.4% had >1 HIV test. At their first visit 78.6% of eligible clients had an HIV test, and out of those who were not tested at the first visit, 28.3% later returned and were tested. HIV incidence among those with HIV status recorded at more than 1 visit was 0.72 per 100 person years (95%CI 0.53-0.98). Overall, 377 clients tested HIV positive at CHIEDZA (prevalence 1.3%) of whom 70.3% linked to care either at CHIEDZA (n=234) or with other service providers (n=31). An additional 1162 clients were previously diagnosed with HIV.
Conclusions: An integrated HIV and SRH programme had high attendance and service uptake, with most clients accessing multiple service components per visit, including HIV testing. Provision of integrated HIV and SRH services may increase service engagement and uptake by youth and facilitate programme efficiency.
Trial registration
The cluster-randomised trial was registered at www.clinicaltrials.gov (Trial registration number: NCT03719521) on 17 October 2018 (https://www.clinicaltrials.gov/study/NCT03719521).