BACKGROUND: Limited engagement with health services contributes to the poorer HIV outcomes observed in youth. We conducted a cluster-randomised trial of a community-based integrated HIV and sexual and reproductive health (SRH) service (CHIEDZA) for youth in 3 provinces in Zimbabwe.
METHODS: Weekly integrated HIV and SRH services were delivered from community centres in 12/24 intervention clusters to cluster residents aged 16-24 years over 30 months. Fingerprint scanning was used to anonymously identify clients and track their attendances and service uptake over time. Services included HIV testing, treatment and adherence support, management of sexually transmitted infections (STIs), menstrual health management, contraception, counselling, and registration for text messages on SRH topics. All services were optional.
RESULTS: In total 36,991 clients attended, for a total of 78,810 visits; each centre had a median of 55 clients per day; 40.6% of clients returned for more than 1 visit. Overall, 75.0% of clients were female and 53.0% were aged <20 years. In total 84.1% of eligible clients had at least one HIV test and 17.4% had more than one. At their first visit 78.6% of eligible clients had an HIV test, and out of those who were not tested at the first visit, 28.3% later returned and were tested. 377 clients tested HIV positive at CHIEDZA (prevalence 1.3%) and 75% linked to care, while 1162 clients were previously diagnosed young people living with HIV. HIV incidence among those with repeated visits was 0.72 per 100 person years (95%CI 0.53-0.98). The most popular services for women were menstrual hygiene products (taken up by 96.5% of those eligible), HIV testing (83.7%) and period pain management (59.9%); for men the most popular were condoms (93.9%), HIV testing (85.6%) and text messages on SRH (67.1%). Among women aged =20 years, 43.7% took condoms and 60.3% took up other forms of contraception.
CONCLUSIONS: An integrated HIV and SRH programme had high attendance and uptake, with most clients taking multiple services per visit, including HIV testing. There is need for accessible, youth-friendly sources of SRH information, menstrual health management, contraception, and HIV testing in Zimbabwe.