Discussion
’
The findings of this trial will inform the scale up of peer-led social mobilization into community-based sexual and reproductive health interventions optimized to support the uptake and retention of adolescents and young adults in long term HIV treatment, HIV pre-exposure prophylaxis and other prevention, and contraception.During the planning phase we liaised with the National and Provincial Department of Health to ensure that the interventions are designed to generate the data needed to scale-up the interventions. We established a working group of health officials that lead HIV testing, prevention and SRH in the district and a nascent technical advisory group in the KZN province. These groups helped us optimize and integrate our existing community-based PrEP delivery with the primary health care; agree the location and distribution of spokes, and the evaluation framework. The main goal of this trial is a scalable ‘decentralised hub and spoke model’ that is aligned with re-engineering of primary care, supports effective (risk-informed) use of biosocial HIV prevention (including PrEP and UTT), and provides the infrastructure to market, test, and rapidly evaluate the implementation of new products. The model is designed to improve sexual health and reduce transmissible HIV amongst young people aged 15–30 in rural KZN, South Africa. We therefore anticipate that if effective the intervention will be scaled up within the district and allow us to test the real-world implementation of newer products such as long-acting PrEP as they emerge. This will potentially harness the full potential of antiretroviral therapy to reduce HIV incidence.