Differentiated care for youth across the HIV care cascade in Zimbabwe

Introduction Youth living with HIV are at higher risk than adults of disengaging from HIV care. Differentiated models of care such as community antiretroviral therapy (ART) may improve treatment outcomes, including viral suppression. Methods This study was nested in a cluster-randomised controlled trial (CHIEDZA: Clinicaltrials.gov, Registration Number: [NCT03719521][1]) which was conducted in Harare, Bulawayo and Mashonaland East Provinces in Zimbabwe and aimed to investigate the impact of a youth-friendly community-based package of HIV services, integrated with sexual and reproductive health services for youth (16–24 years), on population-level HIV viral load (VL). HIV services included HIV testing, ART initiation and continuous care, VL testing, and adherence support. Coverage percentages across the HIV care cascade were analysed. Results Overall 377 youth were newly diagnosed with HIV at CHIEDZA, linkage to HIV care was confirmed for 265 (70.7%, 234 accessed care at CHIEDZA and 31 with other providers); 250 (94.3%) started ART. Among those starting ART at CHIEDZA attrition within 6 months of starting ART was 38% and viral suppression (<1000 copies/ml) among those who had a test at 6 months was 90%. In addition 1162 youth already diagnosed with HIV accessed CHIEDZA; 714 (61.4%) had a VL test, of those 565 (79.1%) were virally suppressed. Conclusion This study shows that provision of differentiated services for youth in the community is feasible. Linkage to care and retention during the initial months of ART was the main challenge as has been shown in other studies. Retention throughout the HIV-care journey for youth needs to become a priority programme goal to achieve the ambitious 95-95-95 UNAIDS targets. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial : [NCT03719521][1] ### Clinical Protocols ### Funding Statement The CHIEDZA study is funded by the Wellcome Trust (Senior Fellowship to RAF: 206316/Z/17/Z). VS and RH were partially supported by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union Grant Ref: MR/R010161/1.The funders did not contribute to the study design, data collection and analysis, decision to publish nor preparation of the manuscript ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval for the CHIEDZA study was obtained from the Medical Research Council of Zimbabwe [MRCZ/A/2387], the Biomedical Research and Training Institute Institutional Review Board [AP149/2018] and the London School of Hygiene & Tropical Medicine Ethics Committee [16124/RR/11602]. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Individual, anonymised participant data and a data dictionary will be available through the London School of Hygiene & Tropical Medicine repository (Data Compass) at the time of publication. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03719521&atom=%2Fmedrxiv%2Fearly%2F2023%2F10%2F12%2F2023.10.11.23296905.atom