Adherence support
youth‐friendly
Participants received product adherence counselling from experienced counsellors at each monthly visit. Counsellors completed a 2‐day training and conducted up to 10 mock counselling sessions before seeing participants. Counselling used a client‐centred approach to frame discussions around empowerment and choice. Cognitive behavioural strategies were incorporated to address adherence barriers [Wi‐Fi scheme to tailor drug‐level feedback messaging to study participants.At each visit, participants were invited to choose from a menu of additional adherence support strategies, including daily two‐way short message service (SMS) reminders, weekly two‐way SMS check‐ins, weekly phone calls, peer buddies, in‐person support clubs (all sites except Johannesburg), online support clubs, extra counselling sessions or other options of the participant's design. Support clubs (both in‐person and online) were facilitated by a site staff member to allow participants to regularly discuss the study, experiences with the pills and ring, and other issues going on in their lives. Participants could select multiple options and change options at any time. A pill‐carrying case was also offered to all participants upon oral PrEP initiation and replaced if needed. These additional support strategies, coupled with the monthly counselling, formed participants’ individualized adherence support plans. Each study site also endeavoured to provide youth‐friendly services that were In March 2020, to comply with social distancing guidelines during the COVID pandemic, in‐person support clubs were paused and additional counselling sessions were offered by phone instead of in‐person (Table 