Impact of integrated community-based HIV and sexual and reproductive health services for youth aged 16-24 years on population-level HIV outcomes in Zimbabwe: the CHIEDZA cluster randomized trial

We conducted a cluster randomized trial of community-based services incorporating HIV testing, treatment and adherence support integrated with sexual and reproductive health services for youth (16-24years) in Zimbabwe . 24 clusters were randomized 1:1 to intervention or control (existing services only). Primary outcome was virological suppression (VS=viral load<1000copies/ml) among youth living with HIV (YLWH), ascertained through a population-level outcome survey of 17,682 youth (18-24years). Secondary outcomes corresponded to UNAIDS 90-90-90 targets. There was no difference by arm in primary outcome (mean cluster prevalence:41.3% (intervention) vs 38.3% (control); RR:1.07 (95%CI:0.88-1.30)), or in proportion of YLWH who were diagnosed. In the intervention arm, a lower proportion of diagnosed YLWH were taking treatment (RR=0.91 (95%CI:0.83-0.99)), but a higher proportion of those taking treatment had VS (RR=1.18 (95%CI:1.02-1.37)). The intervention did not impact proportion of youth with undiagnosed HIV, which explains the effect on primary outcome. Among those taking ART, the intervention improved VS.