Reaching 90 90 90 in Adolescents in Zambia: Using all our SKILLZ

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Project Summary/ Abstract Despite considerable progress, many countries are still struggling to achieve the UNAIDS 90 90 90 targets. These targets have been particularly challenging amongst adolescent girls, with poorer uptake, retention and viral suppression being reported3-6 Grassroot Soccer (GRS) and the Centre for Infectious Disease Research in Zambia (CIDRZ) have collaborated to develop a comprehensive adolescent package that providse sexual and reproductive health services (SRH), including HIV testing and treatment, in adolescent friendly spaces. This program builds off a strong social support with peer mentoring and the use of social networking and adolescent-friendly clinical services that integrate HIV with sexual and reproductive health services (SRH). The `SKILLZ programme' developed for adolescent girls by GRS generates demand for all steps in the HIV cascade among young women. It is a sport-based school intervention, to increase the use of HIV and SRH services and to improve psychosocial well-being, including self-esteem, empowerment, and self-sufficiency. To ensure an uninterrupted continuum of care, we have integrated SKILLZ with CIDRZ teen services to create `SKILLZ Plus', a seamless 90-90-90 pathway for adolescents in Zambia. Instead of focusing on changing young women's attitudes towards their own risk using a medical model, we leverage the power of soccer, local peer mentors and female life coaches to build bridges between young women and services often viewed as inaccessible, distant or irrelevant. Our Specific Aims are to 1.Examine the incremental cost effectiveness of SKILLZ Girl on HIV testing among adolescent girls in secondary schools in Lusaka using a quasi-experimental impact evaluation. 2. Assess the impact of SKILLZ Plus over two years on viral load suppression (Aim 2a) at 6 months and retention at 6 months, 12 months and 24 months (Aim 2b) through an individual-level randomized controlled trial for those who test positive and 3. Identify mediators, predictors and barriers to uptake of SKILLZ Plus (testing, retention and viral load suppression) both quantitatively through mediation and moderation analyses and qualitatively through focus groups discussions (FGD) with coaches and girls.