Community-Based Accompaniment for Adolescents and Young Adults Transitioning into Adult HIV Care: Protocol of a Randomized Control Trial Evaluating the "PASEO" Intervention in Urban Peru.

We describe a randomized controlled trial evaluating a nine-month community-based accompaniment intervention (PASEO) to improve HIV outcomes and well-being among adolescents and young adults living with HIV (AYALWH) entering adult-centered HIV care in Lima, Peru. Participants (ages 14-23) are individually randomized (1:1) to PASEO or a modestly enhanced standard of care, with randomization stratified by health facility and caregiver support. The PASEO intervention aims to build health-related skills, enhance knowledge, promote psychosocial adjustment, and reduce logistical, administrative, and structural barriers to care and adherence. Intervention participants are assigned a health promoter who accompanies them throughout their transition to adult HIV care and coordinates their participation in organized intervention activities. Key elements of PASEO include health system navigation, including accompaniment to appointments and support with administrative procedures; regular in-person visits to foster independent health care management and goal setting, provide social support, and address needs in the home and social environment; individualized adherence support; a low-intensity psychological intervention; peer support groups; and education sessions. Each participant is followed for 24 months. The primary outcome is the cumulative incidence of unsuccessful transition (death, loss to follow-up, or unsuppressed viral load >200 copies/mL after six months of ART) at 12 and 24 months. Secondary outcomes include additional HIV-related indicators (e.g., CD4 count, adherence, clinic attendance) and measures of well-being (e.g., social support, self-efficacy, connectedness, transition readiness, stigma, condomless sex, and depression). Participants who experience the primary outcome are invited to receive intervention services.