4.1. Limitations
This study was subject to many limitations. Firstly, this study had a small sample size. While a larger sample size was envisioned, additional sites were not available for randomization when the study was launched, due to challenges posed by implementing a pragmatic trial during the COVID-19 pandemic. The limited number of facilities in this study coupled with the smaller level of change observed for HIV testing than initially expected resulted in this study being underpowered for the change observed in HIV testing; moreover, this study was not powered for the other outcomes we assessed, which limits the inference we can make on impact due to this intervention. Secondly, we relied on programmatic data for this analysis. While measures are in place to ensure data quality, we were not able to verify the accuracy of data used in this study. Reliance on programmatic data also limited what outcomes we could consider in this analysis; the YHA program could have impacted service delivery in ways that were not be measured by available programmatic indicators [