Background
HIV viral suppression
CNS INFECTIONS, CURB
Despite global concerted efforts to curb the HIV epidemic, South Africa (SA) remains at the epicentre with approximately 8.2 million people in the country living with HIV. Despite effective biomedical tools, including freely available HIV testing, universal test and treat (UTT) and HIV pre-exposure prophylaxis (PrEP) there were an estimated 230,000 new infections in South Africa in 2020, the highest number in the world, with youth aged 15–24 accounting for 32% of these [Although HIV prevalence amongst youth in SA has been declining over recent years, HIV incidence among adolescent girls and young women (AGYW), particularly amongst women aged 20–24, in rural KwaZulu-Natal (KZN) remains high [HIV prevention has advanced in recent years because of new developments in biomedical HIV prevention tools including: HIV point of care tests (POCT) and self-tests [There has been a consistently high burden of poor sexual health among young people in rural KZN [There is growing evidence on the effectiveness of community-based HIV care. A meta-analysis found that community healthcare worker HIV care delivery significantly improved HIV viral suppression, which also reduces sexual transmission [Community-based approaches, when integrated with wider psychosocial care, foster social networks and norms that endorse HIV care and can accelerate progress towards attaining UN sustainable development goal targets [Evidence for peer-led HIV prevention amongst key populations, such as sex workers, men who have sex with men and people who inject drugs, is well established. A 2020 systematic review of the effectiveness of peer-led out-reach amongst key populations found a 36% reduction in HIV incidence [To fill this evidence gap we conducted community-based participatory research to develop and pilot the We hypothesise that social mobilization will attract and engage young people into decentralised SRH services where HIV prevention is tailored to need. Decentralised differentiated biosocial HIV prevention will increase uptake of risk-informed biomedical HIV care and prevention and reduce the overall prevalence of sexually transmissible HIV amongst young people aged 15–30. We are testing our hypotheses in a cluster-randomised stepped wedge trial.