Abstract
BackgroundDespite tremendous progress in controlling the HIV epidemic in sub-Saharan Africa, HIV-related mortality continues to increase among adolescents and young people living with HIV (AYPLHIV). Globally, sub-Saharan Africa accounts for 85% of the AYPLHIV. Overall outcomes along the HIV care cascade are worse among AYPLHIV as compared to all other age groups due to various challenges in accessing and adhering to antiretroviral therapy (ART). New, innovative multicomponent packages of differentiated service delivery (DSD) models, are required to address the specific needs of AYPLHIV. This study aims to evaluate the feasibility and effectiveness of a multicomponent DSD model (PEBRA model) designed for AYPLHIV and coordinated by a peer-educator.MethodsPEBRA (Peer-Educator Based Refill of ART) is a cluster randomized, open-label, superiority trial conducted at 20 health facilities in three districts of Lesotho, Southern Africa. The clusters (health facilities) are randomly assigned to either the PEBRA model or standard of care in a 1:1 ratio, stratified by district. AYPLHIV aged 15–24 years old in care and on ART at one of the clusters are eligible. In the PEBRA model, a peer-educator coordinates the antiretroviral therapy (ART) services - such as medication pick-up, SMS notifications and support options - according to the preferences of the AYPLHIV. The peer-educator delivers this personalized model using a tablet-based application called PEBRApp. The control clusters continue to offer standard of care: ART services coordinated by the nurse. The primary endpoint is viral suppression at 12 months. Secondary endpoints include self-reported adherence to ART, quality of life, satisfaction with care and engagement in care. The target sample size is 300 AYPLHIV. Statistical analyses are conducted and reported in line with CONSORT guidelines for cluster randomized trials.DiscussionThe PEBRA trial will provide evidence on the feasibility and effectiveness of an inclusive, holistic and preference-based DSD model for AYPLHIV that is coordinated by a peer-educator. Many countries in SSA have an existing peer-educator program. If proven effective, the PEBRA model and PEBRApp have the potential to be scaled up to similar settings.Trial registrationClinicaltrials.gov, NCT03969030. Registered on 31 May 2019. More information: www.pebra.info
Highlights
Despite tremendous progress in controlling the Human Immunodeficiency Virus (HIV) epidemic in sub-Saharan Africa, HIV-related mortality continues to increase among adolescents and young people living with HIV (AYPLHIV)
The Peer-Educator-Based Refill of ART (PEBRA) trial will provide evidence on the feasibility and effectiveness of an inclusive, holistic and preference-based differentiated service delivery (DSD) model for AYPLHIV that is coordinated by a peer-educator
Unlike service delivery models that apply standardized care for all people living with HIV, the idea of DSD models is to consider the specific needs of a group of people, while facilitating service scale-up by reducing the burden on health systems and increasing efficiency [16, 17]
Summary
Despite tremendous progress in controlling the HIV epidemic in sub-Saharan Africa, HIV-related mortality continues to increase among adolescents and young people living with HIV (AYPLHIV). Overall outcomes along the HIV care cascade are worse among AYPLHIV as compared to all other age groups due to various challenges in accessing and adhering to antiretroviral therapy (ART). Innovative multicomponent packages of differentiated service delivery (DSD) models, are required to address the specific needs of AYPLHIV. There is encouraging progress towards an AIDS-free generation by 2030 on a global scale This progress is challenged by persistent poor outcomes among young people in sub-Saharan Africa (SSA). Unlike service delivery models that apply standardized care for all people living with HIV, the idea of DSD models is to consider the specific needs of a group of people, while facilitating service scale-up by reducing the burden on health systems and increasing efficiency [16, 17]. The analysis shows that most adolescents are not accessing DSD models even where they exist, an indicator that the existing DSD models are not tailored according to adolescent-specific preferences
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