Developing and Testing a Multi-level Package of Interventions for an Integrated Care Delivery Model of HIV Prevention and Treatment Targeting Adolescent Girls in Zambia

PROJECT SUMMARY/ABSTRACT Zambia has one of the highest incidences of HIV in the world, and adolescent girls and young women (AGYW) are particularly affected. Prior studies and initiatives attempted to provide youth-friendly services through adolescent antiretroviral therapy (ART) clinics that offer a range of services, but these clinics have faced challenges because loss of privacy and the stigma associated with HIV. To address this gap, the Zambian Ministry of Health, RTI International, the Population Council, and the University of North Carolina are collaborating to create an integrated wellness care (IWC) delivery model that targets all HIV-affected AGYW, both those that are HIV negative or do not know their status (HIV-/u) and those that are HIV positive (HIV+). We will test a multilevel package of interventions to connect AGYW with a source of regular care to provide a sustainable platform for successful implementation of regular HIV testing and support for linkage to care, retention in care, and adherence to antiviral treatment. We propose to pursue the following aims: UG3?1. Engage stakeholders by establishing community and youth advisory boards, conduct formative research, adapt modules for behavioral intervention, and develop data collection instruments. UG3?2. Recruit AGYW to establish a sampling frame and perform a discrete choice experiment to systematically evaluate preferences for HIV clinic-based services (1,000 HIV-/u AGYW aged 10 to 20 years and 800 HIV+ AGYW aged 16 to 24 years) to ensure the IWC clinic is tailored to AGYW's needs. UG3?3. Develop standard operating procedures (SOPs) for IWC clinic service delivery and structure, identify and train IWC clinic staff, engage the Youth Advisory Board to create a youth-friendly environment, and conduct a pilot study to evaluate implementation processes (25 AGYW). UH3?1. Assess efficacy at 6 and 12 months of the multilevel interventions at the individual (HIV knowledge, self-efficacy), interpersonal (social support, stigma reduction), and health system (IWC clinic) levels on HIV testing, retention in care, and viral load suppression using a cluster randomized design. UH3?2. Conduct in-depth interviews with clinical staff and peer navigators at 12 months to obtain feedback on the integrated care delivery model to assess sustainability, document best practices, and update SOPs to support scaling up of integrated services for AGYW. UH3?3. Perform cost-effectiveness and budget analysis to evaluate and describe impact along the HIV care continuum and disseminate findings to national partners and the international community. This integrated service delivery model, if successful, can also serve as a platform to implement additional preventive services, including pre-exposure prophylaxis (PrEP) for high-risk AGYW, which is currently under consideration by the government.