Webster Mavhu|Nicola Willis|Juliet Mufuka|Sarah Bernays|Maureen Tshuma|Collin Mangenah|Hendramoorthy Maheswaran|Walter Mangezi|Tsitsi Apollo|Ricardo Araya|Helen A. Weiss|Frances M. Cowan
Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster-randomised controlled trial
Liverpool School of Tropical Medicine|Centre for Sexual Health and HIV AIDS Research|Centre for Sexual Health and HIV AIDS Research|London School of Hygiene & Tropical Medicine|University of Sydney|Centre for Sexual Health and HIV AIDS Research|Centre for Sexual Health and HIV AIDS Research|University of Liverpool|University of Zimbabwe|Ministry of Health and Child Welfare|King's College London|London School of Hygiene & Tropical Medicine|Liverpool School of Tropical Medicine|Centre for Sexual Health and HIV AIDS Research
adolescents living hiv face challenges wellbeing antiretroviral therapy adherence poor treatment outcomes aimed evaluate peerled differentiated service delivery intervention hiv clinical psychosocial outcomes among adolescents hiv zimbabwe16 public primary care facilities clusters two rural districts zimbabwe bindura shamva randomly assigned 11 provide enhanced hiv care support zvandiri intervention group standard hiv care control group adolescents aged 1319 years hiv eligible clinics least 20 adolescents preart art registers geographically separated least 10 km minimise contamination adolescents eligible inclusion living hiv registered hiv care one trial clinics either starting already art exclusion criteria physically unwell attend clinic bedridden psychotic unable give informed assent consent adolescents hiv clinics received adherence support adult counsellors intervention clinics adolescents hiv assigned community adolescent treatment supporter attended monthly support group received text messages calls home visits clinicbased counselling implementation intensity differentiated according adolescents hiv vulnerability reassessed every 3 months caregivers invited support group primary outcome proportion adolescents died viral load least 1000 copies per l 96 weeks indepth qualitative data collected analysed thematically trial registered pan african clinical trial registry number pactr201609001767322between aug 15 2016 march 31 2017 500 adolescents hiv enrolled four excluded group assignment owing testing hiv negative remaining 496 adolescents 212 recruited zvandiri intervention sites 284 control sites enrolment median age 15 years iqr 1417 52 adolescents female 81 orphans 47 viral load least 1000 copies per l 479 97 primary outcome data endline including 28 died 96 weeks 52 25 209 adolescents zvandiri intervention group 97 36 270 adolescents control group hiv viral load least 1000 copies per l died adjusted prevalence ratio 058 95 ci 036094 p003 qualitative data suggested multiple intervention components acted synergistically improve relational context adolescents hiv live supporting improved adherence adverse events judged related study procedures severe adverse events 28 deaths 17 zvandiri intervention group 11 control group 57 admissions hospital 20 zvandiri intervention group 37 control grouppeersupported communitybased differentiated service delivery substantially improve hiv virological suppression adolescents hiv scaled reduce high rates morbidity mortalitypositive action adolescents program viiv healthcare