Table 2. Outline of the CHIEDZA intervention and rationale for choice of components.

Intervention component	Service provided	Eligibility	Rationale
HIV services covering the whole care cascade			•Youth have much worse outcomes at each step of the HIV cascade including •Addressing the whole cascade minimises the risk of attrition at each step
HIV testing	Choice of: •On-site HIV self-testing using OMT with confirmatory testing of HIV+ve test by provider or •Blood-based rapid HIV test by provider + Confirmatory testing of all HIV+ve tests	•All clients of unknown HIV status or having tested HIV-ve >12 months ago or upon request •Testing of partners	•Anticipate high coverage (at least 80%) among youth living with HIV with convenient services in the community, compared to much lower rates through facility-based approach alone 26 •Earlier HIV diagnosis
Linkage to care and ART initiation	•CD4 count for those testing HIV+ve •TB screening •CrAg testing (if CD4 count <100cells/µl) •Referral for management of serious opportunistic infections (if identified) •Cotrimoxazole prophylaxis •ART initiation on-site •Referral for HIV care at partner PHC or to a PHC of client’s choice	•All youth who test HIV+ve or previously tested HIV+ve but not linked to care	•ART initiation at community level kick-starts the linkage to care process 27 •Simplification of ART initiation process (without multiple pre-ART initiation visits) improves linkage to and retention in care 28 •WHO recommending ART regardless of age and disease stage streamlines ART initiation process 29 •ART provision in the community provides flexibility and convenience
Retention in care & ART adherence	•ART refills •HIV viral load monitoring a •Facilitated support groups (CAPS) •Adherence support (defaulter tracing including home visits and SMS messages, specialist counselling)	•Clients with HIV accessing ART through CHIEDZA •Clients with HIV taking ART	•Zimbabwe National Policy recommending ART regardless of age and disease stage streamlines ART initiation process 29 •Zimbabwe has a standard decentralised ART delivery approach •Maintaining contact in the community and community-based support encourages retention in care 30
Sexual and reproductive health services			•Integration of SRH services may increase uptake of HIV testing and other HIV care services •Integration of SRH within HIV care cascade addresses a longstanding gap in programming for youth 31, 32
Menstrual health	Choice of products b : •Reusable pads •Menstrual cup with a starter pack of disposable pads c •Underwear •Analgesia •Information & counselling about products	•Female clients	•Information and counselling insufficient without availability of free or affordable commodities 33 •Provision of MH products enhances acceptability by community and youth and enhances social marketing 34
Family planning	•Emergency contraception (“morning after pill”) •Combined oral contraceptive pills •Progesterone-only pills •Pregnancy testing •3-monthly Depo-Provera injections •Referral for post abortion care •IUCD & Implants (depending on availability of partner providers) d	•Female clients •Condoms provided to males and females	•Information and counselling insufficient without availability of free or affordable commodities 33
STI management	•Syndromic STI management •Partner notification and treatment + In STI CRT intervention clusters only: •Unselected STI testing (Trichomonas vaginalis, Neisseria gonorrhoea and Chlamydia trachomatis) e , free treatment and partner notification for those testing positive	•All clients (and treatment of sexual partners)	•High prevalence of STIs in youth in sub-Saharan Africa •STIs increase the risk of HIV transmission •Syndromic management approach both insensitive and non- specific
Healthy sexual behaviour	•Risk reduction counselling •Condoms f •Expedited referral for VMMC	•All clients •Male clients
Age-appropriate IEC	•General health information g •Bouquet of SMS messages on SRH •Counselling for specific issues including non-health issues •Referral to services h	•All clients	•Improves acceptability and uptake if the intervention is perceived to not have exclusive focus on SRH and HIV and if there is a more holistic approach addressing issues of importance to youth

^aHIV viral load at 6 months, 12 months and annually thereafter for clients initiating ART and accessing HIV care at CHIEDZA. For clients accessing ART elsewhere but attending CHIEDZA for other services, viral load testing offered opportunistically

^bChoice of one option (pads or cup) that can be swapped after 3 months

^cDisposable pads used with a cup initially to provide reassurance that there is no leakage

^dIUCD and implants delivered by partner providers who come at deliver the services at CHIEDZA

^eRepeat STI testing offered after 3 months

^fFlavoured, textured and high quality, with packaging designed to be appealing to youth

^gIncludes an information manual with information on age-appropriate general health and other issues (also available online)

^hReferral to health and other social and educational services relevant to the issue

OMT: Oral mucosal HIV test; TB: Tuberculosis; CrAg: Cryptococcal Antigen; ART: Antiretroviral Therapy; SRH: Sexual and Reproductive Health; IUCD: Intrauterine Contraceptive Device; STI: Sexually Transmitted Infection; VMMC: Voluntary Male Medical Circumcision; IEC: Information, Education and Counselling