The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2025
HIV Testing Uptake in a Sexual and Reproductive Health Service for Youth and Impact on Population-Level Prevalence of Undiagnosed HIV in Zimbabwe.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Larsson Leyla, Simms Victoria, Chikwari Chido Dziva, Bottomley Christian, Bandason Tsitsi, Mugurungi Owen, Apollo Tsitsi, Dauya Ethel, Tembo Mandikudza, Mavodza Constancia, Mackworth-Young Constance R S, Bernays Sarah, Khan Palwasha Y, Hayes Richard J, Kranzer Katharina, Ferrand Rashida A
Аннотация
PURPOSE: High rates of undiagnosed HIV persist among youth. We investigated the uptake of HIV testing within community-based integrated HIV and sexual and reproductive health (SRH) services, and the impact on population-level prevalence of undiagnosed HIV in Zimbabwe.
METHODS: A cluster randomized trial (CHIEDZA) was conducted in three provinces (Harare, Bulawayo, and Mashonaland East) with 8 clusters/province randomized 1:1 to integrated HIV/SRH services for youth aged 16-24 years or to routine existing services for 30 months, followed by a population-level outcome survey. HIV testing uptake within CHIEDZA services, prevalence of population-level undiagnosed HIV, and individual- and community-level factors associated with undiagnosed HIV were assessed.
RESULTS: Overall, 29,827/35,446 (84%) youth who accessed CHIEDZA took up HIV testing, with 92% (27,339/29,827) testing at their first eligible visit. Notably, 98% and 93% of females and males took up another service alongside HIV testing. In the outcome survey, HIV prevalence was 7% (n = 1,226/17,554), of whom 576 (47%) were undiagnosed. There was no difference in prevalence of undiagnosed HIV by trial arm (49% intervention; 45% control). Individual-level factors associated with being undiagnosed were male sex, higher education, no HIV testing history, and inconsistent condom use. Community-level factors associated with undiagnosed HIV were unavailability of SRH services and testing drives, and harmful social norms.
DISCUSSION: Although community-based integrated HIV/SRH achieved high HIV testing uptake, there was no impact on population-level prevalence of undiagnosed HIV. Concerted efforts are needed to identify and reach those at highest risk, and to address structural factors and prevalent social norms.
METHODS: A cluster randomized trial (CHIEDZA) was conducted in three provinces (Harare, Bulawayo, and Mashonaland East) with 8 clusters/province randomized 1:1 to integrated HIV/SRH services for youth aged 16-24 years or to routine existing services for 30 months, followed by a population-level outcome survey. HIV testing uptake within CHIEDZA services, prevalence of population-level undiagnosed HIV, and individual- and community-level factors associated with undiagnosed HIV were assessed.
RESULTS: Overall, 29,827/35,446 (84%) youth who accessed CHIEDZA took up HIV testing, with 92% (27,339/29,827) testing at their first eligible visit. Notably, 98% and 93% of females and males took up another service alongside HIV testing. In the outcome survey, HIV prevalence was 7% (n = 1,226/17,554), of whom 576 (47%) were undiagnosed. There was no difference in prevalence of undiagnosed HIV by trial arm (49% intervention; 45% control). Individual-level factors associated with being undiagnosed were male sex, higher education, no HIV testing history, and inconsistent condom use. Community-level factors associated with undiagnosed HIV were unavailability of SRH services and testing drives, and harmful social norms.
DISCUSSION: Although community-based integrated HIV/SRH achieved high HIV testing uptake, there was no impact on population-level prevalence of undiagnosed HIV. Concerted efforts are needed to identify and reach those at highest risk, and to address structural factors and prevalent social norms.