Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

Abstract Background Despite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa – especially among adolescents and young people. We used community-based participatory research (CBPR), informed by principles social justice, to develop a peer-led biosocial intervention for prevention KwaZulu-Natal (KZN). Methods Between March 2018 September 2019 we CBPR iteratively co-create contextually adap t support prevention. Men women aged 18–30 years were selected community leaders 21 implementation areas ( izigodi ) underwent 20 weeks training as peer-navigators. synthesised quantitative qualitative data collected during 2016–2018 study into 17 vignettes illustrating local drivers HIV. During three development workshops mapping sessions, peer-navigators critically engaged with vignettes, brainstormed solutions mapped components their own izigodi. The plotted Theory Change which, following six-month pilot process evaluation, refined. will be evaluated randomised controlled trial NCT04532307 ). Results Following written oral assessments, 57 108 initially participated two discuss Thetha Nami (`talk me’). included health promotion improve self-efficacy demand prevention, referrals educational resources , aaccessible youth-friendly clinical services uptake approached 6871 people, whom 6141 (89%) accepted 438 linked care. semi-structured interviews described appeal providing sexual information peers similar age background but wanted provide more than just “ onward referral ”. In third workshop 54 refined add components: structured assessment tool tailor referrals, safe spaces advocacy create an enabling environment, peer-mentorship navigation retention Conclusion Local youth able use evidence adapted deliver