JMIR Publications

ABSTRACT

Background:

Zambia has one of the highest rates of prevalence of HIV among adolescents and young adults living with HIV (AYAHIV) in sub-Saharan Africa, who, as of 2023, represent half of all new HIV cases annually. Compared to their peers who are HIV negative, AYAHIV are at an increased risk of developing cancer. The most frequently diagnosed cancers among AYAHIV in Zambia are cervical cancer (CC), Kaposi Sarcoma (KS), and non-Hodgkin’s Lymphoma (NHL). Premature cancer mortality among AYAHIV is driven by late-stage presentation and poor treatment adherence. The objective of this proposed research is to develop and test an integrated model of cancer control for AYAHIV that can be delivered as an embedded component in existing HIV treatment programs in primary care facilities and linked with specialist treatment in cancer centers.

Methods:

We propose a cluster randomized control trial to compare the AYAHIV Role-based Responsibilities for Oncology-focused Workforce (ARROW) program with a one-time education campaign. The ARROW Program consists of interventions at three levels. At the individual level, peer counselors will educate AYAHIV through one-on-one and group education sessions, provide emotional support, and offer care coordination and linkages with the clinical team. At the provider level, collaborative education and training among HIV and oncology workforce will be facilitated. At the health system level, the ARROW Healthcare Collaborative will bring together administrators and policy makers to address system-level barriers. The study will recruit 3,600 AYAHIV across 18 HIV treatment facilities in Lusaka, Zambia between the ages of 15 and 39, who have been on ART for at least 6 months, and are not pregnant in its early detection cohort and 500 AYAHIV who have been diagnosed with CC, KS, or NHL in its cancer treatment cohort. We will also conduct economic evaluations to assess the cost-effectiveness of the ARROW program. Discussion: The ARROW cohort recruitment has begun, and results pertaining to the 12-month endpoints will be available in early 2026. The ARROW program, if shown to be successful, will offer a model for improved linkages and integration between HIV and cancer services to improve cancer prevention, early diagnosis and treatment. Furthermore, ARROW can provide a framework for implementing expanded services, such as survivorship care, for AYAHIV.