Differentiated care for youth across the HIV care cascade in Zimbabwe

IntroductionYouth living with HIV are at higher risk than adults of disengaging from HIV care. Differentiated models of care such as community antiretroviral therapy (ART) may improve treatment outcomes, including viral suppression. MethodsThis study was nested in a cluster-randomised controlled trial (CHIEDZA: Clinicaltrials.gov, Registration Number: NCT03719521) which was conducted in Harare, Bulawayo and Mashonaland East Provinces in Zimbabwe and aimed to investigate the impact of a youth-friendly community-based package of HIV services, integrated with sexual and reproductive health services for youth (16-24 years), on population-level HIV viral load (VL). HIV services included HIV testing, ART initiation and continuous care, VL testing, and adherence support. Coverage percentages across the HIV care cascade were analysed. ResultsOverall 377 youth were newly diagnosed with HIV at CHIEDZA, linkage to HIV care was confirmed for 265 (70.7%, 234 accessed care at CHIEDZA and 31 with other providers); 250 (94.3%) started ART. Among those starting ART at CHIEDZA attrition within 6 months of starting ART was 38% and viral suppression (<1000 copies/ml) among those who had a test at 6 months was 90%. In addition 1162 youth already diagnosed with HIV accessed CHIEDZA; 714 (61.4%) had a VL test, of those 565 (79.1%) were virally suppressed. ConclusionThis study shows that provision of differentiated services for youth in the community is feasible. Linkage to care and retention during the initial months of ART was the main challenge as has been shown in other studies. Retention throughout the HIV-care journey for youth needs to become a priority programme goal to achieve the ambitious 95-95-95 UNAIDS targets.