Community based interventions to improve HIV outcomes in adolescents: a cluster randomised trial in Zimbabwe (360G-Wellcome-206316_Z_17_Z)

HIV infection is the leading cause of mortality among adolescents in sub-Saharan Africa. Adolescents are the only group in which HIV-associated mortality is rising despite the global scale-up of antiretroviral therapy (ART). Adolescents 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 ART is lower, resulting overall in worse virological outcomes. Current services are thus insufficient for achieving optimal outcomes, and complementary strategies are required to meet the UNAIDS 90-90-90 targets. The aim is to investigate whether a community-based, multi-component intervention incorporating HIV prevention, HIV testing, ART initiation, and ongoing adherence support, can improve virological suppression rates among HIV-infected adolescents in a high HIV prevalence setting The objectives are to: Carry out a cluster-randomised trial in Zimbabwe comparing a) facility level HIV services with b) facility-based services plus the community-based intervention. The primary outcome will be proportion of HIV-infected adolescents in the community with an HIV viral load Evaluate the cost and cost-effectiveness of the intervention. To conduct a process evaluation of the intervention’s implementation, to inform components required for sustainability and scalability