The study proposes an implementation science framework to address the HIV prevention and treatment continuum that will inform best practices in identifying high-need young women, providing testing options, and primary HIV prevention as well as linkage to HIV care. The aims of the study are to identify the female youths ages 15- 24 years who are highest at risk for HIV infection in Homa Bay County, Kenya who have not had HIV test within the past six months. We will recruit study participants by utilizing 1) Community-based and 2) Home-based ‘seek’ strategies. We will also evaluate an adaptive intervention to link HIV-positive female youth to HIV treatment. We will randomize participants to receive text-messages/SMS or standard referral and those who do not link to care will be re-randomized to receive 1) one-time financial incentive to link to care compared to 2) SMS reminders. We will also conduct an economic evaluation, using cost-effectiveness analysis, to determine the relative utility of each of the Aims 1-2 seek, test, link, and prevention interventions
The study will compare two ‘seek’ recruitment strategies, three ‘test’ strategies, and two enhancements to an adaptive Sequential, Multiple Assignment, Randomized Trials (SMART) ‘linkage’ to care intervention, among young at-risk women, 15-24 years old, in Homa Bay County, Kenya. Additionally, we will evaluate a scalable primary prevention messaging intervention to support identified HIV-negative young women in reducing HIV risk and adhering to recommended HIV re-testing recommendations.
This design will allow us to follow participants along both the prevention and care continual.