# Self-reported uptake of STI testing services among adolescents and young people aged 15–24 years: Findings from the Yathu Yathu cluster randomized trial in Lusaka, Zambia

## TL;DR

A community-based program in Zambia did not significantly increase STI testing among adolescents and young people, though it showed some benefit for men aged 20–24.

## Contribution

The study evaluates the impact of a peer-led community-based STI screening program on self-reported STI testing among adolescents and young people in Zambia.

## Key findings

- The Yathu Yathu program showed no overall impact on self-reported STI testing among adolescents and young people.
- Among men aged 20–24, self-reported ever STI testing was higher in the Yathu Yathu arm compared to the control.
- Only 6.6% of those who ever STI tested reported being diagnosed with an STI.

## Abstract

There is little evidence regarding community-based delivery of STI testing and treatment for youth aged 15–24 (AYP) in Zambia. In a cluster-randomised trial, we evaluated whether offering syndromic STI screening through community-based, peer-led sexual and reproductive health services (Yathu Yathu) with referral to a local health facility for testing, increased self-reported testing for STIs (other than HIV) among AYP. Two communities in Lusaka were divided into 10 zones each (20 zones in total); by community, zones were randomly allocated (1:1) to Yathu Yathu or control. Monitoring data were used to describe syndromic STI screening through Yathu Yathu and an endline cross-sectional survey used to evaluate the impact of Yathu Yathu on self-reported ever and recent (last 12 months) STI testing. 10,974 AYP accessed Yathu Yathu; 66.6% (females—67.7%; males—64.7%) were screened for STIs, 6.2% reported any STI symptoms. In the endline survey, 23.3% (n = 350/1501) of AYP who ever had sex ever STI tested; 13.5% (n = 174/1498) who had sex in the last 12 months recently STI tested. By trial arm, there was no difference in self-reported ever or recent STI testing among all AYP. Among men aged 20–24, there was evidence that ever STI testing was higher in the Yathu Yathu compared to control arm (24.1% vs 16.1%; adjPR = 1.67 95%CI = 1.02, 2.74; p = 0.04). Among AYP who ever STI tested, 6.6% (n = 23) reported ever being diagnosed with an STI. Syndromic STI management through community-based, peer-led services showed no impact on self-reported STI testing among AYP. Research on community-based delivery of (near) point-of-care diagnostics is needed.

Trial registration number(s): NCT04060420 https://clinicaltrials.gov/ct2/show/NCT04060420; and ISRCTN75609016; https://doi.org/10.1186/ISRCTN75609016.