LSHTM STIRIG Newsletter: Sexual Health & Adolescence

Yathu Yathu is a 3-year cluster randomised trial and embedded process and economic evaluation of comprehensive, peer-led and incentivised sexual and reproductive health (SRH) services for adolescents and young people aged 15-24 (AYP) in Lusaka, Zambia. The study is being led by Prof Helen Ayles in collaboration with colleagues at LSHTM (Dr Bernadette Hensen, Sian Floyd, Prof Richard Hayes) and in partnership with Zambart and Imperial College. The Yathu Yathu intervention was co-developed with AYP in a formative phase and subsequently implemented in September 2019.

As part of the intervention, comprehensive SRH services are delivered through community-based hubs run by peer support workers. Between September 2019 and January 2020, ~6000 AYP (63% female) attended the hubs. Overall, 75% of all AYP tested for HIV at the hubs. In March 2020, implementation of Yathu Yathu was halted due to COVID-19. During this time, community engagement activities (funded by an LSHTM public engagement grant awarded to research degree student Mwelwa Phiri) were developed to provide accurate information to AYP about COVID-19 prevention using social media platforms (WhatsApp and Facebook). Activities included a music video developed by the peer support workers and information videos using poetry in local languages. All videos developed by the peer support workers, alongside the Yathu Yathu anthem and a virtual tour of what to expect at the hubs, can be found here.

In July, service delivery resumed, with adaptations to protect staff and participants from COVID-19, and increasing numbers of AYP are accessing services. A endline survey to estimate the impact of the intervention will be conducted in March 2021.

UPTAKE
In partnership with the International AIDS Vaccine Initiative (IAVI), the Medical Research Council-Uganda Virus Research Institute Research and LSHTM, Uganda Research Unit (MRC/UVRI & LSHTM), the Kenya AIDS Vaccine Initiative-Institute of Clinical Research (KAVI-ICR), Busara Center for Behavioural Economics, and the East African Health Research Commission (EAHRC), LSHTM have been awarded EDCTP funding to conduct the UPTAKE study. Investigators include Mitzy Gafos, Fern Terris-Prestholt, Pitchaya Indravudh, and Janet Seeley at LSHTM and Agnes Ssali and Yunia Mayanja at MRC Uganda.

UPTAKE will utilize behavioural economics research approaches to i) understand facilitators and barriers for uptake and retention of future injectable and implantable long-acting HIV prevention products and multi-purpose prevention technologies which can simultaneously provide protection from multiple outcomes such as HIV, other STIs and/or unintended pregnancy, ii) measure the strength of preferences for various products and how these preferences are segmented by user profiles, iii) design interventions that will be tested for their impact on retention of users of contraceptive products, as models for adherence to new technologies, and iv) estimate cost and cost-effectiveness of long acting products and interventions that could be uniquely provided in the context of a suite of self-care SRH products.

The overall aim of the study is to determine factors that will facilitate future uptake of HIV prevention products and multi-purpose prevention technologies to prevent HIV and unwanted pregnancy among girls and young women in Sub-Saharan Africa. The study will focus on the needs of at-risk adolescent girls and young women and female sex workers and include qualitative research with policy makers and health care providers. It will be implemented in Kenya and Uganda in early 2021. The study will accelerate access to innovate products by directly influencing development of long acting HIV prevention products in the formulation, device, delivery and packaging space, and enabling the licensure of better suited HIV prevention products to lower HIV incidence.

STICH
Effective STI control in adolescents and young people is a key priority in low and middle-income countries, where syndromic management is currently the standard of care. This is especially relevant in regions of high STI/HIV prevalence. Newer STI diagnostics integrated into HIV and SRH services may provide an integrated, unsiloed solution. CHIEDZA is a cluster randomised trial offering a package of SRH services incorporating HIV prevention, HIV testing, contraception, menstrual hygiene management and counselling for young people aged 16 to 24 years in the community. The trial is being carried out in 24 clusters across 3 provinces (Harare, Bulawayo and Mashonaland East) in Zimbabwe. Within CHIEDZA; the MRC funded STICH (STIs within CHIEDZA; PIs Suzanna Francis , Rashida Ferrand and Richard Hayes) study will evaluate an STI testing intervention using newer STI diagnostic methods. Through STICH, all CHIEDZA clients will be offered testing for three curable STIs (chlamydia, gonorrhoea and trichomoniasis) using Xpert CT/NG and the OSOM TV rapid diagnostic test. Staff training was conducted this September, led by Dr Francis, Ms Chido Dziva Chikwari (STICH and CHIEDZA Study coordinator), Ms Ethel Dauya (CHIEDZA Study Coordinator), Ms Tsitsi Bandason (CHIEDZA data manager) and the Zimbabwe Ministry of Health and Child Care National STI Prevention Coordinator, Ms Anna Machiha. The STICH intervention will start on October 1^st and will run for 1 year in each province; followed by a community based prevalence survey in 2021.

Staff training in use of point-of-care STI testing for the STITCH study in Zimbabwe