The Community PrEP Study: a randomized control trial leveraging community-based platforms to improve access and adherence to pre-exposure prophylaxis to prevent HIV among adolescent girls and young women in South Africa-study protocol

Andrew Medina-Marino, Dana Bezuidenhout, Sybil Hosek, Ruanne V Barnabas, Millicent Atujuna, Charl Bezuidenhout, Phuti Ngwepe, Remco P H Peters, Francesca Little, Connie L Celum, Joseph Daniels, Linda-Gail Bekker, Andrew Medina-Marino, Dana Bezuidenhout, Sybil Hosek, Ruanne V Barnabas, Millicent Atujuna, Charl Bezuidenhout, Phuti Ngwepe, Remco P H Peters, Francesca Little, Connie L Celum, Joseph Daniels, Linda-Gail Bekker

Abstract

Background: HIV incidence among South African adolescent girls and young women (AGYW) remains high, but could be reduced by highly effective pre-exposure prophylaxis (PrEP). Unfortunately, AGYW report significant barriers to clinic-based sexual and reproductive health services. Even when AGYW access PrEP as an HIV prevention method, poor prevention-effective use was a serious barrier to achieving its optimal HIV prevention benefits. Determining the acceptability and feasibility of community-based platforms to increase AGYW's access to PrEP, and evaluating behavioural interventions to improve prevention-effective use of PrEP are needed.

Methods: We propose a mixed-methods study among AGYW aged 16-25 years in Eastern Cape Province, South Africa. In the first component, a cross-sectional study will assess the acceptability and feasibility of leveraging community-based HIV counselling and testing (CBCT) platforms to refer HIV-negative, at-risk AGYW to non-clinic-based, same-day PrEP initiation services. In the second component, we will enrol 480 AGYW initiating PrEP via our CBCT platforms into a three-armed (1:1:1) randomized control trial (RCT) that will evaluate the effectiveness of adherence support interventions to improve the prevention-effective use of PrEP. Adherence will be measured over 24 months via tenofovir-diphosphate blood concentration levels. Qualitative investigations will explore participant, staff, and community experiences associated with community-based PrEP services, adherence support activities, study implementation, and community awareness. Costs and scalability of service platforms and interventions will be evaluated.

Discussion: This will be the first study to assess the acceptability and feasibility of leveraging CBCT platforms to identify and refer at-risk AGYW to community-based, same-day PrEP initiation services. It will also provide quantitative and qualitative results to inform adherence support activities and services that promote the prevention-effective use of PrEP among AGYW. By applying principles of implementation science, behavioural science, and health economics research, we aim to inform strategies to improve access to and prevention-effective use of PrEP by AGYW.

Trial registration: ClinicalTrials.gov NCT03977181 . Registered on 6 June 2019-retrospectively registered.

Keywords: Adherence support intervention; Adolescent girls and young women; Community-based delivery platforms; Cost-effectiveness; HIV; HIV prevention; PrEP; Randomized controlled trial; South Africa.

Conflict of interest statement

The authors have no competing interests related to this study.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Provincial map of South Africa showing location of study communities within Buffalo City Metro Health District, Eastern Cape Province

References

    1. UNAIDS . Ending AIDS: Progress towards the 90–90–90 targets. Geneva: Joint United Nations Programme on HIV/AIDS; 2017.
    1. Gouws E, Stanecki KA, Lyerla R, Ghys PD. The epidemiology of HIV infection among young people aged 15-24 years in southern Africa. AIDS Lond Engl. 2008;22(Suppl 4):S5–16. doi: 10.1097/01.aids.0000341773.86500.9d.
    1. Mavedzenge SN, Weiss HA, Montgomery ET, Blanchard K, de Bruyn G, Ramjee G, et al. Determinants of differential HIV incidence among women in three southern African locations. J Acquir Immune Defic Syndr 1999. 2011;58(1):89–99. doi: 10.1097/QAI.0b013e3182254038.
    1. Naranbhai V, Abdool Karim SS, Altfeld M, Samsunder N, Durgiah R, Sibeko S, Abdool Karim Q, Carr WH, the CAPRISA004 TRAPS team Innate immune activation enhances HIV acquisition in women, diminishing the effectiveness of tenofovir microbicide gel. J Infect Dis. 2012;206(7):993–1001. doi: 10.1093/infdis/jis465.
    1. Pettifor AE, Rees HV, Kleinschmidt I, Steffenson AE, MacPhail C, Hlongwa-Madikizela L, Vermaak K, Padian NS. Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS Lond Engl. 2005;19(14):1525–1534. doi: 10.1097/01.aids.0000183129.16830.06.
    1. Cluver LD, Orkin FM, Meinck F, Boyes ME, Sherr L. Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents. J Int AIDS Soc. 2016;19(1):20646. doi: 10.7448/IAS.19.1.20646.
    1. Wamoyi J, Mshana G, Mongi A, Neke N, Kapiga S, Changalucha J. A review of interventions addressing structural drivers of adolescents’ sexual and reproductive health vulnerability in sub-Saharan Africa: implications for sexual health programming. Reprod Health. 2014;11(1):88. doi: 10.1186/1742-4755-11-88.
    1. Simbayi L, Zuma K, Zungu N, Moyo S, Marinda E, Jooste S, et al. South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017. 2019.
    1. Pettifor A, O’Brien K, Macphail C, Miller WC, Rees H. Early coital debut and associated HIV risk factors among young women and men in South Africa. Int Perspect Sex Reprod Health. 2009;35(2):82–90. doi: 10.1363/3508209.
    1. Hallett TB, Gregson S, Lewis JJC, Lopman BA, Garnett GP. Behaviour change in generalised HIV epidemics: impact of reducing cross-generational sex and delaying age at sexual debut. Sex Transm Infect. 2007;83(Suppl 1):i50–i54. doi: 10.1136/sti.2006.023606.
    1. de Oliveira T, Kharsany ABM, Gräf T, Cawood C, Khanyile D, Grobler A, Puren A, Madurai S, Baxter C, Karim QA, Karim SSA. Transmission networks and risk of HIV infection in KwaZulu-Natal, South Africa: a community-wide phylogenetic study. Lancet HIV. 2017;4(1):e41–e50. doi: 10.1016/S2352-3018(16)30186-2.
    1. Jewkes RK, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet Lond Engl. 2010;376(9734):41–48. doi: 10.1016/S0140-6736(10)60548-X.
    1. Jewkes RK, Levin JB, Penn-Kekana LA. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Soc Sci Med 1982. 2003;56(1):125–134.
    1. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, Montoya-Herrera O, Fernández T, Veloso VG, Buchbinder SP, Chariyalertsak S, Schechter M, Bekker LG, Mayer KH, Kallás EG, Amico KR, Mulligan K, Bushman LR, Hance RJ, Ganoza C, Defechereux P, Postle B, Wang F, McConnell J, Zheng JH, Lee J, Rooney JF, Jaffe HS, Martinez AI, Burns DN, Glidden DV, iPrEx Study Team Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–2599. doi: 10.1056/NEJMoa1011205.
    1. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, Katabira E, Ronald A, Tumwesigye E, Were E, Fife KH, Kiarie J, Farquhar C, John-Stewart G, Kakia A, Odoyo J, Mucunguzi A, Nakku-Joloba E, Twesigye R, Ngure K, Apaka C, Tamooh H, Gabona F, Mujugira A, Panteleeff D, Thomas KK, Kidoguchi L, Krows M, Revall J, Morrison S, Haugen H, Emmanuel-Ogier M, Ondrejcek L, Coombs RW, Frenkel L, Hendrix C, Bumpus NN, Bangsberg D, Haberer JE, Stevens WS, Lingappa JR, Celum C, Partners PrEP Study Team Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410. doi: 10.1056/NEJMoa1108524.
    1. Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, Chiamwongpaet S, Kitisin P, Natrujirote P, Kittimunkong S, Chuachoowong R, Gvetadze RJ, McNicholl JM, Paxton LA, Curlin ME, Hendrix CW, Vanichseni S. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet Lond Engl. 2013;381(9883):2083–2090. doi: 10.1016/S0140-6736(13)61127-7.
    1. Amico KR, Mansoor LE, Corneli A, Torjesen K, van der Straten A. Adherence support approaches in biomedical HIV prevention trials: experiences, insights and future directions from four multisite prevention trials. AIDS Behav. 2013;17(6):2143–2155. doi: 10.1007/s10461-013-0429-9.
    1. Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, Henderson FL, Pathak SR, Soud FA, Chillag KL, Mutanhaurwa R, Chirwa LI, Kasonde M, Abebe D, Buliva E, Gvetadze RJ, Johnson S, Sukalac T, Thomas VT, Hart C, Johnson JA, Malotte CK, Hendrix CW, Brooks JT. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–434. doi: 10.1056/NEJMoa1110711.
    1. Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–422. doi: 10.1056/NEJMoa1202614.
    1. Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, Palanee T, Nakabiito C, van der Straten A, Noguchi L, Hendrix CW, Dai JY, Ganesh S, Mkhize B, Taljaard M, Parikh UM, Piper J, Mâsse B, Grossman C, Rooney J, Schwartz JL, Watts H, Marzinke MA, Hillier SL, McGowan I, Chirenje ZM, VOICE Study Team Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372(6):509–518. doi: 10.1056/NEJMoa1402269.
    1. Angotti N, Bula A, Gaydosh L, Kimchi EZ, Thornton RL, Yeatman SE. Increasing the acceptability of HIV counseling and testing with three C’s: convenience, confidentiality and credibility. Soc Sci Med 1982. 2009;68(12):2263–2270.
    1. Mathews C, Guttmacher SJ, Flisher AJ, Mtshizana YY, Nelson T, McCarthy J, Daries V. The quality of HIV testing services for adolescents in Cape Town, South Africa: do adolescent-friendly services make a difference? J Adolesc Health Off Publ Soc Adolesc Med. 2009;44(2):188–190. doi: 10.1016/j.jadohealth.2008.05.009.
    1. Strauss M, Rhodes B, George G. A qualitative analysis of the barriers and facilitators of HIV counselling and testing perceived by adolescents in South Africa. BMC Health Serv Res. 2015;15(1):250. doi: 10.1186/s12913-015-0922-0.
    1. DiClemente RJ, Crosby RA. Preventing HIV among adolescents in Sub-Saharan Africa. J Adolesc Health Off Publ Soc Adolesc Med. 2009;44(2):101–102. doi: 10.1016/j.jadohealth.2008.12.001.
    1. MacPhail CL, Pettifor A, Coates T, Rees H. “You must do the test to know your status”: attitudes to HIV voluntary counseling and testing for adolescents among South African youth and parents. Health Educ Behav Off Publ Soc Public Health Educ. 2008;35(1):87–104.
    1. Hagey JM, Akama E, Ayieko J, Bukusi EA, Cohen CR, Patel RC. Barriers and facilitators adolescent females living with HIV face in accessing contraceptive services: a qualitative assessment of providers’ perceptions in western Kenya. J Int AIDS Soc. 2015;18(1):20123. doi: 10.7448/IAS.18.1.20123.
    1. McLaren ZM, Ardington C, Leibbrandt M. Distance decay and persistent health care disparities in South Africa. BMC Health Serv Res. 2014;14(1):541. doi: 10.1186/s12913-014-0541-1.
    1. Bekker L-G, Johnson L, Wallace M, Hosek S. Building our youth for the future. J Int AIDS Soc. 2015;18(2 Suppl 1):20027. doi: 10.7448/IAS.18.2.20027.
    1. Medina-Marino A, Mumbauer A, Farirai T, Bekker L, Johnson S, Nkhwashu N. High uptake of community-based HIV testing by adolescent girls and young women aged 15-24: Implications and Synergies for PrEP Roll Out? 9th International AIDS Society on HIV Science. Paris: Abstract TUAC0201; 2017.
    1. Nachega JB, Adetokunboh O, Uthman OA, Knowlton AW, Altice FL, Schechter M, Galárraga O, Geng E, Peltzer K, Chang LW, van Cutsem G, Jaffar SS, Ford N, Mellins CA, Remien RH, Mills EJ. Community-based interventions to improve and sustain antiretroviral therapy adherence, retention in HIV care and clinical outcomes in low- and middle-income countries for achieving the UNAIDS 90-90-90 Targets. Curr HIV/AIDS Rep. 2016;13(5):241–255. doi: 10.1007/s11904-016-0325-9.
    1. Duwell MM, Knowlton AR, Nachega JB, Efron A, Goliath R, Morroni C, Maartens G, Chaisson RE. Patient-nominated, community-based HIV treatment supporters: patient perspectives, feasibility, challenges, and factors for success in HIV-infected South African adults. AIDS Patient Care STDs. 2013;27(2):96–102. doi: 10.1089/apc.2012.0348.
    1. Jaffar S, Amuron B, Foster S, Birungi J, Levin J, Namara G, Nabiryo C, Ndembi N, Kyomuhangi R, Opio A, Bunnell R, Tappero JW, Mermin J, Coutinho A, Grosskurth H, Jinja trial team Rates of virological failure in patients treated in a home-based versus a facility-based HIV-care model in Jinja, southeast Uganda: a cluster-randomised equivalence trial. Lancet Lond Engl. 2009;374(9707):2080–2089. doi: 10.1016/S0140-6736(09)61674-3.
    1. Luque-Fernandez MA, Van Cutsem G, Goemaere E, Hilderbrand K, Schomaker M, Mantangana N, et al. Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa. PLoS One. 2013;8(2):e56088. doi: 10.1371/journal.pone.0056088.
    1. Mills EJ, Lester R, Thorlund K, Lorenzi M, Muldoon K, Kanters S, Linnemayr S, Gross R, Calderon Y, Amico KR, Thirumurthy H, Pearson C, Remien RH, Mbuagbaw L, Thabane L, Chung MH, Wilson IB, Liu A, Uthman OA, Simoni J, Bangsberg D, Yaya S, Bärnighausen T, Ford N, Nachega JB. Interventions to promote adherence to antiretroviral therapy in Africa: a network meta-analysis. Lancet HIV. 2014;1(3):e104–e111. doi: 10.1016/S2352-3018(14)00003-4.
    1. Bedelu M, Ford N, Hilderbrand K, Reuter H. Implementing antiretroviral therapy in rural communities: the Lusikisiki model of decentralized HIV/AIDS care. J Infect Dis. 2007;196(Suppl 3):S464–S468. doi: 10.1086/521114.
    1. Psaros C, Haberer JE, Katabira E, Ronald A, Tumwesigye E, Campbell JD, et al. An intervention to support HIV preexposure prophylaxis adherence in HIV-serodiscordant couples in Uganda. J Acquir Immune Defic Syndr 1999. 2014;66(5):522–529. doi: 10.1097/QAI.0000000000000212.
    1. Andersen LS, Magidson JF, O’Cleirigh C, Remmert JE, Kagee A, Leaver M, Stein DJ, Safren SA, Joska J. A pilot study of a nurse-delivered cognitive behavioral therapy intervention (Ziphamandla) for adherence and depression in HIV in South Africa. J Health Psychol. 2018;23(6):776–787. doi: 10.1177/1359105316643375.
    1. Rosenstein D, Seedat S. Child and adolescent cognitive behaviour therapy in South Africa: An editorial review. J Child Adolesc Ment Health. 2011;23(2):69–73. doi: 10.2989/17280583.2011.644447.
    1. Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet Lond Engl. 2008;372(9642):902–909. doi: 10.1016/S0140-6736(08)61400-2.
    1. Bere T, Nyamayaro P, Magidson JF, Chibanda D, Chingono A, Munjoma R, Macpherson K, Ndhlovu CE, O’Cleirigh C, Kidia K, Safren SA, Abas M. Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva. J Health Psychol. 2017;22(10):1265–1276. doi: 10.1177/1359105315626783.
    1. South African National Department of Health. South African District Level HIV Estimates, 2016. Pretoria: South African National Department of Health; 2017.
    1. Fisher JD, Amico KR, Fisher WA, Harman JJ. The information-motivation-behavioral skills model of antiretroviral adherence and its applications. Curr HIV/AIDS Rep. 2008;5(4):193–203. doi: 10.1007/s11904-008-0028-y.
    1. Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol Off J Div Health Psychol Am Psychol Assoc. 2006;25(4):462–473.
    1. Horvath KJ, Smolenski D, Amico KR. An empirical test of the information-motivation-behavioral skills model of ART adherence in a sample of HIV-positive persons primarily in out-of-HIV-care settings. AIDS Care. 2014;26(2):142–151. doi: 10.1080/09540121.2013.802283.
    1. Byrne D, Kelley K, Fisher WA. Unwanted teenage pregnancies: incidence, interpretation, and intervention. Appl Prev Psychol J Am Assoc Appl Prev Psychol. 1993;2(2):101–113. doi: 10.1016/S0962-1849(05)80116-7.
    1. Safren SA, O’Cleirigh C, Tan JY, Raminani SR, Reilly LC, Otto MW, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol Off J Div Health Psychol Am Psychol Assoc. 2009;28(1):1–10.
    1. Celum C, Mgodi N, Bekker L, Hosek S, Donnell D, Anderson P, et al. PrEP adherence and effect of drug level feedback among young African women in HPTN 082. Mexico City: IAS 2019: 10th IAS Conference on HIV Science; 2019.
    1. Celum C, Gill K, Morton J, Stein G, Thomas, McConnell M, et al. Incentives conditioned on tenofovir levels to increase adherence among young women on PrEP in Cape Town. Mexico City: IAS 2019: 10th IAS Conference on HIV Science; 2019.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. doi: 10.1016/j.jbi.2008.08.010.
    1. South African National Department of Health. HIV Testing Services: Policy 2016 [Internet]. Pretoria; 2016. [cited 2020 Dec 29]. Available from:
    1. Baron D, Ramskin L, Joubert M, Wits Reproductie Health and HIV Institute. Get PrEPPared What African women need to know! [Internet]. Johannesburg: Umuzi Films; 2017. [cited 2020 Dec 29]. Available from: .
    1. Sumartojo E. Structural factors in HIV prevention: concepts, examples, and implications for research. AIDS Lond Engl. 2000;14(Suppl 1):S3–10. doi: 10.1097/00002030-200006001-00002.
    1. Rhodes T. The ‘risk environment’: a framework for understanding and reducing drug-related harm. Int J Drug Policy. 2002;13(2):85–94. doi: 10.1016/S0955-3959(02)00007-5.
    1. Burke HM, Chen M, Murray K, Bezuidenhout C, Ngwepe P, Bernholc A, Medina-Marino A. The effects of the integration of an economic strengthening and HIV prevention education programme on the prevalence of sexually transmitted infections and savings behaviours among adolescents: a full-factorial randomised controlled trial in South Africa. BMJ Glob Health. 2020;5(4):e002029. doi: 10.1136/bmjgh-2019-002029.
    1. Claassen JN. The benefits of the CAGE as a screening tool for alcoholism in a closed rural South African community. South Afr Med J Suid-Afr Tydskr Vir Geneeskd. 1999;89(9):976–979.
    1. Cholera R, Gaynes BN, Pence BW, Bassett J, Qangule N, Macphail C, Bernhardt S, Pettifor A, Miller WC. Validity of the Patient Health Questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. J Affect Disord. 2014;167:160–166. doi: 10.1016/j.jad.2014.06.003.
    1. Bruwer B, Emsley R, Kidd M, Lochner C, Seedat S. Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth. Compr Psychiatry. 2008;49(2):195–201. doi: 10.1016/j.comppsych.2007.09.002.
    1. South African National Department of Health . Sexually Transmitted Infections: Management Guidelines 2015 [Internet] Pretoria: Department of Health; 2014.
    1. National Institute for Communicable Diseases, Centre for Vaccines and Immunology . Vaccine Information for Parents and Caregivers [Internet] Johannesburg: National Institute for Communicable Diseases; 2016.
    1. Castillo-Mancilla JR, Zheng J-H, Rower JE, Meditz A, Gardner EM, Predhomme J, Fernandez C, Langness J, Kiser JJ, Bushman LR, Anderson PL. Tenofovir, emtricitabine, and tenofovir diphosphate in dried blood spots for determining recent and cumulative drug exposure. AIDS Res Hum Retroviruses. 2013;29(2):384–390. doi: 10.1089/aid.2012.0089.
    1. Daniels J, De Vos L, Mogos W, Olivier D, Shamu S, Mudau M, et al. Factors influencing sexually transmissible infection disclosure to male partners by HIV-positive pregnant women in Pretoria townships, South Africa: a qualitative study. Sex Health. 2019;16(3):274–281. doi: 10.1071/SH18177.
    1. Bekker L-G, Rebe K, Venter F, Maartens G, Moorhouse M, Conradie F, Wallis C, Black V, Harley B, Eakles R. Southern African guidelines on the safe use of pre-exposure prophylaxis in persons at risk of acquiring HIV-1 infection. South Afr J HIV Med. 2016;17(1):455. doi: 10.4102/sajhivmed.v17i1.455.
    1. Kanters S, Park JJ, Chan K, Ford N, Forrest J, Thorlund K, et al. Use of peers to improve adherence to antiretroviral therapy: a global network meta-analysis. J Int AIDS Soc. 2016;19(1):21141. doi: 10.7448/IAS.19.1.21141.
    1. Simoni JM, Huh D, Frick PA, Pearson CR, Andrasik MP, Dunbar PJ, et al. Peer support and pager messaging to promote antiretroviral modifying therapy in Seattle: a randomized controlled trial. J Acquir Immune Defic Syndr 1999. 2009;52(4):465–473. doi: 10.1097/QAI.0b013e3181b9300c.
    1. Nabukeera-Barungi N, Elyanu P, Asire B, Katureebe C, Lukabwe I, Namusoke E, Musinguzi J, Atuyambe L, Tumwesigye N. Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda. BMC Infect Dis. 2015;15(1):520. doi: 10.1186/s12879-015-1265-5.
    1. Safren SA, Otto MW, Worth JL, Salomon E, Johnson W, Mayer K, et al. Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring. Behav Res Ther. 2001;39(10):1151–1162. doi: 10.1016/S0005-7967(00)00091-7.
    1. Denison JA, Banda H, Dennis AC, Packer C, Nyambe N, Stalter RM, Mwansa JK, Katayamoyo P, McCarraher DR. “The sky is the limit”: adhering to antiretroviral therapy and HIV self-management from the perspectives of adolescents living with HIV and their adult caregivers. J Int AIDS Soc. 2015;18(1):19358. doi: 10.7448/IAS.18.1.19358.
    1. Mutumba M, Musiime V, Lepkwoski JM, Harper GW, Snow RC, Resnicow K, Bauermeister JA. Examining the relationship between psychological distress and adherence to anti-retroviral therapy among Ugandan adolescents living with HIV. AIDS Care. 2016;28(7):807–815. doi: 10.1080/09540121.2015.1131966.
    1. Grimsrud A, Lesosky M, Kalombo C, Bekker L-G, Myer L. Implementation and operational research: community-based adherence clubs for the management of stable antiretroviral therapy patients in Cape Town, South Africa: A Cohort Study. J Acquir Immune Defic Syndr 1999. 2016;71(1):e16–e23. doi: 10.1097/QAI.0000000000000863.
    1. South African National Department of Health . Adherence Guidlines for HIV, TB and NCDs: Policy and Service Delivery Guidelines [Internet] Pretoria: National Department of Health; 2016.
    1. Gill K, Johnson L, Dietrich J, Myer L, Marcus R, Wallace M, Pidwell T, Mendel E, Fynn L, Jones K, Wiesner L, Slack C, Strode A, Spiegel H, Hosek S, Rooney J, Gray G, Bekker LG. Acceptability, safety, and patterns of use of oral tenofovir disoproxil fumarate and emtricitabine for HIV pre-exposure prophylaxis in South African adolescents: an open-label single-arm phase 2 trial. Lancet Child Adolesc Health. 2020;4(12):875–883. doi: 10.1016/S2352-4642(20)30248-0.
    1. Celum CL, Delany-Moretlwe S, Baeten JM, van der Straten A, Hosek S, Bukusi EA, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22(Suppl 4):e25298.

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