Study design and participants
The PEBRA trial was a cluster-randomized, open label, pragmatic clinical trial conducted at 20 rural nurse-led health facilities (clusters) in Butha-Buthe, Leribe, and Mokhotlong districts of Lesotho, Southern Africa. The 20 health facilities serve a rural population in a mountainous area with poor infrastructure. We decided to conduct this trial only across nurse-led clinics in rural areas because these are the most common health facilities across Lesotho, they provide standardized services (e.g., important for the control arm comparison) and the population they serve reports generally worse HIV outcomes compared to the population served at the district hospitals [Eligible clusters were public or missionary nurse-led clinics (not hospitals) offering ART services to a rural population, situated in an area with stable cell phone signal, willing to participate, and with a PE who passed the study-specific training assessment. Young people were eligible for inclusion if they were living with HIV, registered for HIV care at one of the eligible clusters, aged 15 to 24 years, taking ART, and able to provide informed consent.