Completed Pregnancy, Children & Inherited Conditions Diabetes, Hormones & Metabolism

Community based interventions to improve HIV outcomes in adolescents: a cluster randomised trial in Zimbabwe

Funder Wellcome Charity-funded
Recipient organisation London School of Hygiene & Tropical Medicine
Funding £3.1M
Period Oct 2017 — Oct 2022

In plain English

AI plain-English summary

In Zimbabwe, a community-based programme will send trained workers into neighbourhoods to help teenagers get tested for HIV, start treatment, and stay on it. HIV is the leading cause of death among adolescents in sub-Saharan Africa, and this age group is the only one where HIV-related deaths are still rising, even as global treatment access expands. Teenagers are far less likely than adults to know their HIV status, to be on antiretroviral therapy, or to have the virus suppressed. The trial will compare standard clinic-based care against a package that adds home-based HIV testing, peer support groups, and adherence counselling delivered in the community. The primary measure is the proportion of HIV-infected adolescents whose viral load falls below 1000 copies per millilitre—a threshold indicating effective treatment. If the intervention works, it could offer a practical, scalable model for reaching the UNAIDS 90-90-90 targets in high-prevalence settings. The study also includes a cost-effectiveness analysis and a process evaluation to identify which components are essential for sustainability, so that health ministries in similar contexts can decide whether to adopt the approach.

View original technical description
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: 1. 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 <1000copies/ml 2. Evaluate the cost and cost-effectiveness of the intervention. 3. To conduct a process evaluation of the intervention’s implementation, to inform components required for sustainability and scalability

View the original record at the funder ↗

Researchers

Rashida Ferrand (EPMC Awardee)

Related Research

Grants with similar aims, by meaning.

Improving HIV testing and care for adolescents in Zimbabwe: A targeted, community-based approach
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An investigation of interventions to increase uptake of HIV self-testing and linkage to post-test services among higher education students in Zimbabwe
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Original classification

Senior Research Fellowship Clinical

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