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PEBRA Trial – Effect Of A Peer-educator Coordinated Preference-based ART Service Delivery Model On Viral Suppression Among Adolescents And Young Adults Living With HIV: Protocol Of A Cluster-randomized Clinical Trial In Rural Lesotho

Thabo Lejone, Mathebe Kopo, Nadine Bachmann, J. A. Brown, T. Glass, Josephine Muhairwe, T. Matsela, Ramona Scherrer, Lebohang Chere, T. Namane, N. Labhardt, A. Amstutz
Published 2020 · Medicine

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Background 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). 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. Methods PEBRA ( P eer- E ducator B ased R efill of A RT) 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. Discussion The 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 registration Clinicaltrials.gov , NCT03969030 . Registered on 31 May 2019. More information: www.pebra.info
This paper references
10.1097/QAD.0b013e3283578b9b
Risk factors, barriers and facilitators for linkage to antiretroviral therapy care: a systematic review
D. Govindasamy (2012)
10.7448/IAS.20.5.21649
High rates of retention and viral suppression in the scale-up of antiretroviral therapy adherence clubs in Cape Town, South Africa
P. Tsondai (2017)
10.1371/journal.pmed.1002433
A combination intervention strategy to improve linkage to and retention in HIV care following diagnosis in Mozambique: A cluster-randomized study
B. Elul (2017)
10.1097/QAD.0b013e328355d67b
The HIV care continuum: no partial credit given.
M. McNairy (2012)
10.7448/IAS.20.4.21520
Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic
A. Slogrove (2017)
10.1016/S2352-3018(16)30206-5
Interventions to improve adherence to antiretroviral therapy: a systematic review and network meta-analysis.
S. Kanters (2017)
10.7448/IAS.19.1.21484
Reimagining HIV service delivery: the role of differentiated care from prevention to suppression
A. Grimsrud (2016)
PATA Technical Brief about Differentiated Service Delivery for Adolescents and Young Adults Living with HIV in South Africa
(2019)
10.1097/01.aids.0000183124.86335.0a
Evaluation of a peer support group therapy for HIV-infected adolescents
I. Funck-Brentano (2005)
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
World Health Organization, et al. Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation
M L Plummer (2017)
10.1371/journal.pmed.1002420
Effectiveness of a combination strategy for linkage and retention in adult HIV care in Swaziland: The Link4Health cluster randomized trial
M. McNairy (2017)
Differentiated Care for HIV: A Decision Framework for Antiretroviral Therapy. Durban, South Africa: IAS
(2016)
Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middleincome countries: a systematic review
C Hudelson (2015)
Zvandiri Trial Policy Brief
(2019)
10.1002/jia2.25028
Greater retention in care among adolescents on antiretroviral treatment accessing “Teen Club” an adolescent‐centred differentiated care model compared with standard of care: a nested case–control study at a tertiary referral hospital in Malawi
Rachel K MacKenzie (2017)
Miles to go: Closing gaps, breaking barriers, righting injustices
(2018)
10.1186/s12889-019-6447-4
Effectiveness of community adolescent treatment supporters (CATS) interventions in improving linkage and retention in care, adherence to ART and psychosocial well-being: a randomised trial among adolescents living with HIV in rural Zimbabwe
Nicola Willis (2019)
10.1097/QAI.0000000000001751
Ensuring Children and Adolescents Are Not Left Behind
L. Bekker (2018)
Adolescent-friendly health services for adolescents living with HIV: from theory to practice
Antiretroviral Therapy Enrollment Characteristics and Outcomes Among HIV-Infected Adolescents and Young Adults Compared with Older Adults — Seven African Countries, 2004–2013
A. Auld (2014)
10.1080/09540121.2015.1011073
Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review
Carly Hudelson (2015)
Global Accelerated Action for the Health of Adolescents
ML Plummer (2020)
The Link4Health cluster randomized trial
ML McNairy (2020)
Providing differentiated delivery to children and adolescents
WhoIas (2018)
A Decision Framework for differentiated antiretroviral therapy delivery for children, adolescents and pregnant and breastfeeding women
(2017)
10.1007/s10461-016-1537-0
Barriers and Facilitators to Interventions Improving Retention in HIV Care: A Qualitative Evidence Meta-Synthesis
B. Hall (2016)
10.1016/S1084-8045(02)00061-9
Publisher's Note
H. V. D. Togt (2003)
10.7448/IAS.18.7.20745
Targeting 90–90–90 – don't leave children and adolescents behind
M. Davies (2015)



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