Description of the PEBRA model and clusters. ART, antiretroviral therapy; PEBRA, Peer Educator-Based Refill of ART.
First, the PE explained all options within each domain to the participant (The PEBRA model and the PEBRApp were developed in close collaboration with PEs, young people living with HIV, youth activists, clinicians, district Ministry of Health authorities, Sentebale youth leaders, SolidarMed and Swiss Tropical and Public Health Institute research staff as well as local and international mobile application developers. During a series of workshops, these stakeholders defined the current main challenges in adolescent HIV care in Lesotho, possible strategies within the PEBRA model to overcome these challenges building on existing resources at the study health facilities, the role of the PE within the PEBRA model, and the scope and design of the PEBRApp. Due to limited access to smartphones in rural Lesotho, the consensus from the formative workshop series was to build an application for the PEs only, with a communication channel between PE and participants based on SMS technology. As such, the PEBRApp helped the PE not only to collect data, regularly assess the preferences of their peers, and to keep track of the ART refill and next assessment dates, but also ensured regular contact between the PE and the participant. More details and screenshots about the PEBRApp are provided in the published study protocol [Before starting the trial, the PEs completed a 1-week training camp that covered obtaining informed consent, administering study-specific questionnaires, the use of the PEBRApp, and how to deliver PEBRA model. The PEs were recruited from Sentebale’s longstanding PE program in collaboration with the Ministry of Health and the SolidarMed study coordinator, received a monthly stipend and were closely supervised by the attached health facility staff and the study coordinator.At health facilities randomized to the control arm, the study participants received the standard of care offered at nurse-led rural health facilities in Lesotho, i.e., ART refill at the clinic and nurse-led support (