An investigation of interventions to increase uptake of HIV self-testing and linkage to post-test services among higher education students in Zimbabwe

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Adolescents and young people in Africa have the worst health outcomes of adolescents and young people globally, in large part because of the high rate of new HIV infections, particularly among young women. Despite this, young people are less likely to know their HIV status than older adults and as such are less likely to benefit from prevention and treatment options. The population of young Africans is set to double in the next 30 years meaning that if nothing is done to improve young people's access to HIV prevention and care, the number of new infections in young people will also double. This project targets young students attending higher education institutions with a novel intervention, HIV self-testing, aimed at improving their uptake of HIV testing and supporting them to take up prevention and care services. HIV self-testing, where people test themselves for HIV infection, has been shown to be safe and accurate and of importance here, highly acceptable to young people who desire privacy and autonomy when testing. I propose to compare the effectiveness and cost and cost effectiveness of two models of distributing HIV self-testing among students, in a trial where higher education institutions are allocated by chance to one of two distribution models. Outcomes include: i) uptake of self-testing, ii) linkage to HIV prevention and care services depending on their HIV result and, iii) cost per person tested, diagnosed positive and started on treatment or preventive service. The two HIV self-test distribution models to be compared are a peer-led plus mass-media supported model with a mass media only model. I will also develop an internet based tool to measure distribution of self-test kits and support and measure subsequent engagement with services. I will then explore how to adapt these self-testing models for young people to other settings (eg schools or workplaces) and to support prevention and care for other chronic diseases in young people (eg hypertension or poor mental health).