A Centre of Excellence for Biomedical Research and Training In Africa
Community based interventions to improve HIV outcomes in young people: A cluster randomised trial in Zimbabwe
PI: Professor Rashida Ferrand
CHIEDZA is a cluster randomised trial which is Community based interventions to improve the HIV outcomes in young people. Adolescents and Young People (AYP) fare disproportionately poorly across the HIV care continuum compared to other age-groups: the prevalence of undiagnosed HIV is substantially higher, and coverage of and adherence to ART is lower, resulting overall in worse virological outcomes.
Aim: The aim is to determine the impact of an integrated community-based package of HIV services incorporating HIV testing, linkage to care and ongoing adherence support, combined with sexual and reproductive health services and general health services on population level HIV viral load among AYP (defined in this study as those aged between 16 to 24 years) in a high HIV prevalence setting.
Design: This is a two-arm cluster-randomised trial in 24 clusters randomised 1:1 to standard of care or to the intervention package.
Intervention: Community-based package of services for AYP that includes: HTC, ART delivery ART, CAPS groups and mhealth for adherence support, condoms, MHM, STI treatment, contraception, referral for VMMC, risk reduction counselling and general health information and counselling. The intervention will be implemented over a two-year period. The intervention will be implemented in 12 clusters, each with a population of approximately 2500 AYP.
Study Outcomes: The study outcomes will be determined at a population level through a community cross-sectional survey two years following the implementation of the intervention. The primary outcome is the proportion of AYP with HIV with a Viral load < 1000 copies/ml. The secondary outcomes will reflect each step of the HIV care cascade:
Proportion with HIV who know their HIV status, proportion of those who know their status who are taking ART, of those who know their HIV-positive status, who are currently taking ART, proportion of those taking ART who are virally suppressed. SRH knowledge, risks and behaviour will also be assessed.
Study population: The end-line survey will recruit 1000 18-24 year olds per cluster (total 24000).
Study sites: The studywill be conducted in 3 provinces in Zimbabwe: Harare, Mashonaland East and Mashonaland West.
Study Duration: The planned duration of the entire study will be 4 years
This project is funded by the Wellcome Trust.
Chiedza’s Song: growing up with HIV in Zimbabwe (2015)
Chiedza’s song tells the true story of a young woman growing up with HIV in Harare. Its message is positive. Chiedza overcomes serious illness and family rejection to get to university and find love. The film was designed with the participation of young people living with HIV in Harare, to challenge the stereo-typed images of HIV still prevalent. It is shot entirely through Chiedza’s eyes so that the audience sees what she sees and hears what she thinks. Tatenda, the other main character in the film, voices a central theme that the nature of HIV has changed from a killer disease to a manageable condition in which those infected should not get sick, or infect others. But the image of HIV is still dominated by past prevention campaigns which used fear to change behaviour. Instead the film emphasises the enormous benefits of modern HIV treatment, and the negative impact of stigma and prejudice, which have become the main barriers to getting treatment to everyone who needs it.
The film was built around a research project (ZENITH) funded by the Wellcome Trust, by the Harare based Biomedical Research and Training Institute (BRTI) and the London School of Hygiene and Tropical Medicine. The research, which was led by Professor Rashida Ferrand, found a two percent prevalence for 8 to 18 year olds, with around half of young people unaware they are infected and not getting treatment. Often the adults around them do not want children to get tested, for fear of revealing their own infection. Seventy percent of the children who tested positive and were unaware of their status, had a parent or sibling on HIV treatment. Chiedza’s story is typical in this way. She suspects her father is HIV infected and wants
to get her siblings tested, but her father flatly refuses.
The film, which is in two parts, is designed to provoke discussion and has been shown in Community Halls in Harare in the neighbourhoods where the Zenith Project took place. In showings in Harare, one of the main characters, Tatenda walks out from behind the screen at the end of the first part to start the discussion, with questions arising from his character in the film. A short ending is then played after the discussion. A school’s pack has been developed in Zimbabwe, in partnership with the Ministry of Education, to roll the film out to secondary schools. The themes are universal enough, that the film could also be used in other countries. A facilitation guide can be downloaded to help planning events in schools.
The film Project was funded by the Wellcome Trust.