Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster-randomised controlled trial

Publication date: Available online 7 January 2020Source: The Lancet Global HealthAuthor(s): 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 CowanSummaryBackgroundAdolescents living with HIV face challenges to their wellbeing and antiretroviral therapy adherence and have poor treatment outcomes. We aimed to evaluate a peer-led differentiated service delivery intervention on HIV clinical and psychosocial outcomes among adolescents with HIV in Zimbabwe.Methods16 public primary care facilities (clusters) in two rural districts in Zimbabwe (Bindura and Shamva) were randomly assigned (1:1) to provide enhanced HIV care support (the Zvandiri intervention group) or standard HIV care (the control group) to adolescents (aged 13–19 years) with HIV. Eligible clinics had at least 20 adolescents in pre-ART or ART registers and were geographically separated by at least 10 km to minimise contamination. Adolescents were eligible for inclusion if they were living with HIV, registered for HIV care at one of the trial clinics, and either starting or already on ART. Exclusion criteria were being too physically unwell to attend clinic (bedridden), psychotic, or unable to give informed assent or consent. Adolescents with HIV at all clinics received adherence support through adult counsellors. At intervention clinics, adolescents with HIV were assigned a comm...
Source: The Lancet Global Health - Category: International Medicine & Public Health Source Type: research