TY  - JOUR
AU  - Subramanian, Sujha
AU  - Edwards, Patrick
AU  - Roberts, Sarah T
AU  - Musheke, Maurice
AU  - Mbizvo, Michael
PY  - 2019
DA  - 2019/10/3
TI  - Integrated Care Delivery for HIV Prevention and Treatment in Adolescent Girls and Young Women in Zambia: Protocol for a Cluster-Randomized Controlled Trial
JO  - JMIR Res Protoc
SP  - e15314
VL  - 8
IS  - 10
KW  - HIV
KW  - prevention
KW  - treatment
KW  - Zambia
KW  - adolescent girls and young women
AB  - Background: Among countries in sub-Saharan Africa, Zambia has one of the highest incidences of HIV. Adolescent girls and young women (AGYW) are a particularly affected group because of their social and economic vulnerability. Objective: The goal of this study is to test a multilevel package of interventions at the community and health system levels in Zambia in order to connect AGYW with a source of regular care, which will in turn allow for sustainable, successful implementation of regular HIV testing and adherence to antiretroviral treatment. Methods: We will adapt prior tools to create the SHIELD (Support for HIV Integrated Education, Linkages to Care, and Destigmatization) intervention to educate and empower Zambian AGYW of 10-24 years of age and their families and to create community-based youth clubs to foster peer support. We will also develop integrated wellness care clinics to offer a youth-friendly environment that provides tailored clinical services. We will perform formative research, including focus groups and in-depth interviews, among AGYW, caregivers, and stakeholders to help inform the development and tailoring of the interventions. A cluster-randomized controlled trial will be implemented in Lusaka, with six clinic catchment areas randomized into three groups: zones with integrated wellness care clinics and SHIELD intervention, zones with only SHIELD intervention, and control zones with no intervention. We will assess HIV testing among the HIV-negative or unknown (HIV-/u) cohort, and retention in care along with viral load suppression will be evaluated in the HIV-positive (HIV+) cohort. We will use in-depth interviews and surveys to collect staff and stakeholder feedback after the trial. Cost-effectiveness of the interventions and return-on-investment impacts will be quantified using a microsimulation model. Results: Interim results are expected in 2021, and the final results are expected in 2022. If this multilevel intervention is successful in establishing a comprehensive care continuum for HIV-affected AGYW, the Zambian Ministry of Health may advocate for expansion to additional settings to support national scale-up. Conclusions: This integrated service delivery model can also be a platform to implement additional preventive services, so HIV-/u and HIV+ AGYW can receive comprehensive, integrated services. Trial Registration: ClinicalTrials.gov NCT03995953; https://clinicaltrials.gov/ct2/show/NCT03995953  International Registered Report Identifier (IRRID): PRR1-10.2196/15314 
SN  - 1929-0748
UR  - https://www.researchprotocols.org/2019/10/e15314
UR  - https://doi.org/10.2196/15314
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31584004
DO  - 10.2196/15314
ID  - info:doi/10.2196/15314
ER  -