The Implementation and Costs To Deliver a youth-friendly multi-component Program Addressing Stigma, HIV, and Linkage To Care for Adolescent Girls and Young Women in Lusaka, Zambia.

Abstract

Community-centered HIV prevention is most effective among adolescent girls and young women (AGYW) when integrated with youth-friendly health care services; yet gaps in the literature remain about the costs and the processes of these services. We describe the implementation and costs of two intervention components: (1) the Support for HIV Integrated Education, Linkages to care, and Destigmatization (SHIELD) program, which includes a monthly group session for AGYW with content on social support, stigma, and self-efficacy in health care seeking-behaviors; and (2) the Integrated Wellness Care (IWC) clinic that provided HIV testing along with other sexual and reproductive health services in a youth-friendly clinical setting. Data (e.g., youth club attendance, daily time reporting) come from a cluster randomized trial (ClinicalTrials.gov NCT03995953) conducted in four communities in Lusaka, Zambia. The economic cost of the SHIELD component per client was approximately twice that of the IWC component per client; the greatest costs for SHIELD included participant follow-up (scheduling and session reminders). Those receiving only the SHIELD component attended an average of 7.4 group sessions and those receiving both SHIELD and IWC components attended an average of 6.6 group sessions. Understanding the processes for implementation and delivery costs of behavioral interventions integrated with existing health care models is needed to inform scale-up and adaptation, particularly for policymakers who require understanding intervention costs to make such decisions. By capturing labor and efforts to navigate clients into care we better understand the full cost of sustaining health programs and long-term health care needs of populations.