Discussion
DSD
EVENTS
The PEBRA trial was a pragmatic cluster-randomized clinical trial to assess the effectiveness of a youth DSD model, whereby PEs supported young people living with HIV, regularly asked them about their service preferences in terms of SMS notifications, ART refill location, and psychosocial support and delivered care accordingly.Overall, viral suppression increased from 166/307 (54%) at baseline to 194/307 (63%) at 12 months of follow-up. However, there was no conclusive evidence of a significantly higher rate of viral suppression at 12 months among participants in the intervention clusters compared to standard of care. We found that arms were similar in terms of engagement in care, transfer out, self-reported adherence, QoL, and satisfaction with care.An estimated 2.1 million young people aged 15 to 24 years old are living with HIV in Southern and Eastern Africa [Three systematic reviews involving studies from 2001 to 2016 evaluated the evidence on interventions to improve engagement in HIV care among adolescents and young adults [One of the largest peer-support programs for adolescents living with HIV in sub-Sahara Africa is the Zvandiri program that started in Zimbabwe and engages a cadre of 18- to 24-year-old community adolescent treatment supporters (CATS) [A literature search revealed 2 other randomized trials that evaluated a support intervention for adolescents living with HIV in sub-Sahara Africa and reported virological outcomes [Two major events occurred in Lesotho during the trial period: the large-scale rollout of DTG [PEBRA trial had several limitations. First, in both groups, 9% of participants in care at 12 months had a missing VL measurement, thus classified as having an unsuppressed VL, which may have underestimated the viral suppression rates. However, the proportion of missing VLs was similar to previous pragmatic trials in the same study districts [This trial is one of few randomized clinical trials focusing on DSD among young people living with HIV. During the study period of the PEBRA trial, viral suppression rates in both groups increased by 9%. Preference-based peer-coordinated care for young people living with HIV, compared to nurse-based care only, did not lead to conclusive evidence for an effect on viral suppression. More large-scale research is needed to understand the effect of peer-led models of care among the youth.