Browsing by Author "Thandeka Khoza"

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    Isisekelo Sempilo study protocol for the efectiveness of HIV prevention embedded in sexual health with or without peer navigator support (Thetha Nami) to reduce prevalence of transmissible HIV amongst adolescents and young adults in rural KwaZulu-Natal: a 2×2 factorial randomised controlled trial
    (2022) Glory Chidumwa; Natsayi Chimbindi; Carina Herbst; Nonhlanhla Okeselo; Jaco Dreyer; Thembelihle Zuma; Theresa Smith; Jean‑Michel Molina; Thandeka Khoza; Nuala McGrath; Janet Seeley; Deenan Pillay; Frank Tanser; Guy Harling; Lorraine Sherr; Andrew Copas; Kathy Baisley; Maryam Shahmanesh
    Background: Antiretroviral therapy (ART) through universal test and treat (UTT) and HIV pre-exposure prophylaxis (PrEP) substantially reduces HIV-related mortality, morbidity and incidence. Efective individual-level prevention modalities have not translated into population-level impact in southern Africa due to sub-optimal coverage among adolescents and youth who are hard to engage. We aim to investigate the feasibility, acceptability, and preliminary population level efectiveness of HIV prevention services with or without peer support to reduce prevalence of trans‑ missible HIV amongst adolescents and young adults in KwaZulu-Natal. Methods: We are conducting a 2×2 factorial trial among young men and women aged 16–29 years, randomly selected from the Africa Health Research Institute demographic surveillance area. Participants are randomly allocated to one of four intervention combinations: 1) Standard of Care (SOC): nurse-led services for HIV testing plus ART if posi‑ tive or PrEP for those eligible and negative; 2) Sexual and Reproductive Health (SRH): Baseline self-collected vaginal and urine samples with study-organized clinic appointments for results, treatment and delivery of HIV testing, ART and PrEP integrated with SRH services; 3) Peer-support: Study referral of participants to a peer navigator to assess their health, social and educational needs and provide risk-informed HIV prevention, including facilitating clinic attendance; or 4) SRH+peer-support. The primary outcomes for efectiveness are: (1) the proportion of individuals with infectious HIV at 12 months and (2) uptake of risk-informed comprehensive HIV prevention services within 60 days of enrolment. At 12 months, all participants will be contacted at home and the study team will collect a dried blood spot for HIV ELISA and HIV viral load testing. Discussion: This trial will enable us to understand the relative importance of SRH and peer support in creating demand for efective and risk informed biomedical HIV prevention and preliminary data on their efectiveness on reducing the prevalence of transmissible HIV amongst all adolescents and youth. Trial registration: Trial Registry: clincialtrials.gov. ClinicalTrials.gov Identifer NCT04532307. Registered: March 2020. Keywords: Peer navigator, HIV prevention, Community-based care, Contraception, Pre-Exposure prophylaxis
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    Protocol: Mapping social networks, social influence and sexual health among youth in rural KwaZulu-Natal, the Sixhumene cohort study
    (2022-05-26) Vuyiswa Nxumalo; Siyabonga Nxumalo; Theresa Smit; Thandeka Khoza; Fikile Mdaba; Thulile Khumalo; Beniamino Cislaghi; Nuala McGrath; Janet Seeley; Maryam Shahmanesh; Guy Harling
    Background: Sexual behaviour and sexually transmitted infections are strongly affected by social connections, and interventions are often adapted more readily when diffused through social networks. However, evidence on how young people acquire ideas and change behaviour through the influence of important social contacts is not well understood in high-HIV-prevalence settings, with the result that past peer-led HIV-prevention interventions have had limited success. Methods: We therefore designed a cohort study (named Sixhumene or ‘we are connected’) to follow young people in three rural and small-town communities in uMkhanyakude district, KwaZulu-Natal, South Africa, and the people that these youth identify as important in their lives. We will interview them five times over three years, at each visit collecting information on their socioeconomic, social and sexual health lives, and testing them for HIV and herpes simplex virus 2 (HSV-2). We will use this information to understand how these young people’s sexual health decisions are formed. This will include evaluating how poor sexual health outcomes are correlated across social networks, how youth mimic the attitudes and behaviours of those around them, who is at greatest risk of acquiring HIV and HSV-2, and who might be most influential within communities and thus best able to promote protective interventions. Discussion: The information gathered through this study will allow us to describe social connection and influence spread through these real-world social networks, and how this leads to sexual health outcomes. Sixhumene will provide vital inputs for mathematical models of communities and spreading processes, as well as inform the development of effective interventions to protect the sexual health of community members through appropriate targeting with optimised messaging requiring fewer resources.