NIHR GRP: Using innovations in intervention and evaluation to reduce sexual transmission of HIV The NIHR Global Research Professorship scheme is open to all professions and Higher Education Institutions in England and the Devolved Administrations, to nominate health researchers and methodologists with an outstanding clinical and applied health research record and its effective translation for improved health. Global Research Professors are required to have existing strong links with partners in institutions in countries on the OECD DAC list and the award should plan to support training and capacity development in these partners.

My goal is to bring the benefits of recent advances in HIV prevention to stem the HIV epidemic and its negative impact on young people in South Africa. I will do this through a peer-led community-based package of biomedical HIV prevention and psychosocial support that is tailored to young persons’ need. 
Despite huge advances in HIV treatment and prevention, HIV related ill-health and death remains a huge problem in South Africa.  7.7 million people are living with HIV and young people bear the brunt of both the health and socioeconomic impact of the HIV pandemic. The anticipated doubling in number of young people over the next twenty years underscores the urgency of developing scalable models of delivering HIV prevention alongside treatment. 
The study will be conducted amongst men and women aged 16-30 living in a poor, rural area of KwaZulu-Natal:  
In the first 18 months we will use participatory research to optimise Thetha Nami (a peer-navigator delivered HIV prevention intervention for young people). We will:
a) optimise the peer navigator needs assessment tool so that vulnerable and at risk individuals receive more support
b) refine the social support and peer mentorship components of the intervention
c) establish safe clinical pathways for delivery of sexual health self-care to young people
d) identify ways to use routine service use data to identify groups that need increased support
In the second 30 months we will test this intervention in a randomised controlled trial. 3000 men and women aged 16-30 will be selected at random from the study area, ensuring gender and age balance.  If they agree to participate they will be randomly offered one of four intervention combinations:  a) usual care: clinic based HIV testing and treatment if positive and biomedical prevention if negative; b) the peer-led biosocial intervention c) the sexual health self-care kit and d) combination of the peer-led intervention and sexual health self-care kits. The participants will then be followed up after 24 months for an interviewer administered survey and a finger prick test for HIV. 
The main outcome is the effect of the interventions on reducing sexually transmissible HIV. This is defined as participants remaining HIV negative, or, if living with HIV, starting antiretroviral therapy and having an undetectable HIV viral load.  We will also measure the effect of the intervention/s on sexual and mental health and quality of life.  
We involved patients and the public to iteratively co-create the peer-led intervention. We will engage young people throughout the study. This will include strengthening the youth advisory component of our community advisory board, delivery of interventions through peer-navigators, and involvement of youth on the project steering committee. I will use participatory dissemination workshops to understand enablers and ensure that these interventions are equitable in their reach.  
The final output will be a well-defined and scalable implementation strategy to reduce the negative impact of HIV on youth in South Africa. It will comprise a feasible approach to identify those at risk, and then deliver an intervention to improve uptake and effective use of HIV prevention and care.  By engaging our technical advisory group, which includes service users and providers and health policy makers, we are confident that we will generate the evidence needed to scale-up the interventions. Aims and objectives:  The goal of my fellowship is to stem the HIV epidemic and it’s negative impact on young people in SA through effective implementation of advances in HIV prevention.  
Specific aim one:  I will use community based participatory research to optimise risk-differentiated and tailored biosocial HIV prevention for young people in rural KZN
Optimise the risk-differentiation (where more vulnerable and at risk individuals receive more support), and the psychosocial components of the intervention delivered by the peer navigators
Establish safe clinical pathways to support decentralised PrEP, ART, and sexual health selfcare
Use routine service use data to identify groups that need increased support
Specific aims two:  I will use a 4X2 factorial randomised controlled trial and process evaluation to evaluate the effectiveness and scalability of risk-differentiated and tailored biosocial HIV prevention delivered by peers to reduce the prevalence of sexually transmissible HIV among 16-30-year-old men and women
Evaluate the effectiveness and cost effectiveness of the risk-differentiated and tailored biosocial HIV prevention delivered by peers to reduce the prevalence of transmissible HIV
Conduct a process evaluation of the acceptability, feasibility, and equitable reach of each component of the intervention