Evidence map›Paper›PMID 40555749›Full record

Trial reportNature medicine2025

Integrated community-based HIV and sexual and reproductive health services for youth: a cluster-randomized trial.

Rashida A Ferrand, Ethel Dauya, Chido Dziva Chikwari, Tsitsi Bandason, Sarah Bernays, Constance Mackworth-Young, Aoife M Doyle, Chris Grundy, Pitchaya Indravudh, Fern Terris-Prestholt and 10 more

Erratum issued Registry-linked trialAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Nature medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT03719521 (Community Based Interventions to Improve HIV Outcomes in Youth), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03719521 nacompletednot on this map

Community Based Interventions to Improve HIV Outcomes in Youth: a Cluster Randomised Trial in Zimbabwe (CHIEDZA)

TypeinterventionalSponsorLondon School of Hygiene and Tropical MedicineRan2019 to 2022Enrolled36,991ConditionsHIV InfectionArmsCommunity-based package of integrated HIV, SRH and general health services
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors.

Rashida A FerrandClinical Research Department, London School of Hygiene & Tropical Medicine, London, UK. rashida.ferrand@lshtm.ac.uk.ORCID http://orcid.org/0000-0002-7660-9176
Ethel DauyaThe Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
Chido Dziva ChikwariThe Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
Tsitsi BandasonThe Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.ORCID http://orcid.org/0000-0003-0066-8345
Sarah BernaysFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Constance Mackworth-YoungThe Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
Aoife M DoyleThe Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.ORCID http://orcid.org/0000-0002-3305-7738
Chris GrundyDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Pitchaya IndravudhDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
Fern Terris-PrestholtDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
Constancia Vimbayi MavodzaThe Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
Owen MugurungiAIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe.
Tsitsi ApolloAIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe.
Getrude NcubeAIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe.
Leyla LarssonThe Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.ORCID http://orcid.org/0000-0003-4869-4630
Ona McCarthyDepartment of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Victoria SimmsThe Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
Mandikudza TemboThe Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
Katharina KranzerClinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.ORCID http://orcid.org/0000-0001-5691-7270
Richard J HayesDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.

Funding

Wellcome Trust 206316Wellcome Trust (Wellcome) 206316/Z/17/Z
6 · The paper itself

Abstract

Human immunodeficiency virus (HIV) viral suppression rates are disproportionately worse in youth compared to other age groups, and improving this will require addressing the whole HIV cascade, including HIV testing, linkage to care and support to maintain viral suppression. We conducted a cluster-randomized trial of community-based services incorporating HIV testing, treatment and adherence support integrated with sexual and reproductive health (SRH) services for youth (16-24 years) in Zimbabwe. Our hypothesis was that integrated services in community-based settings would increase demand and access. In total, 24 clusters (geographically demarcated areas) were randomized 1:1 to intervention or control (existing services). Primary outcome was virological suppression (defined as HIV viral load <1,000 copies per ml) among youth with HIV (YWH), ascertained through a population-level outcome survey of 17,682 youth (18-24 years). Secondary outcomes, corresponding to UNAIDS 90-90-90 targets, were the proportion of YWH who knew their HIV status, the proportion of YWH who knew their HIV status who were taking antiretroviral therapy (ART) and the proportion of YWH taking ART who achieved viral suppression (HIV viral load <1,000 copies per ml). There was no difference by arm in primary outcome (mean cluster prevalence-41.3% (intervention) versus 38.3% (control); risk ratio (RR)-1.07 (95% confidence interval (CI), 0.88-1.30)) or in proportion of YWH who were diagnosed. In the intervention arm, a lower proportion of diagnosed YWH were taking treatment (RR = 0.91 (95% CI, 0.83-0.99)), but a higher proportion of those on ART had viral suppression (RR = 1.18 (95% CI, 1.02-1.37)). The intervention did not impact the proportion of youth with undiagnosed HIV, which explains the lack of effect on the primary outcome. Among those taking treatment, the intervention improved viral suppression. Delivery of integrated HIV and SRH services was feasible and facilitated uptake by youth of essential services beyond HIV, addressing an important programmatic gap. Trial registration number: NCT03719521 .

Indexed as

Community Health ServicesHIV InfectionsReproductive Health ServicesAdolescentFemaleHumansMaleViral LoadYoung AdultZimbabwe

Identifiers

PMID40555749
PMCPMC7617871

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.