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We conducted a pilot hybrid effectiveness\u2010implementation trial (CHOMA) to evaluate whether an evidence\u2010based mental health intervention adapted for PrEP delivery (\u201cYouth Friendship Bench SA\u201d) could address CMD and PrEP adherence among South African AGYW.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>CHOMA was conducted in Johannesburg from April 2023 to February 2024. We enrolled AGYW (18\u221225 years) who were already on or willing to initiate PrEP and had CMD symptoms (Self\u2010Reporting Questionnaire 20\u2010item [SRQ\u201020]\u22657). Participants were randomized to our Youth Friendship Bench SA intervention (five problem\u2010solving sessions with a lay counsellor, one group session) or standard\u2010of\u2010care CMD services (brief CMD assessment, referral). Counselling sessions occurred at enrolment and Weeks 2, 4, 8 and 12. Co\u2010primary outcomes were PrEP adherence (positive result on a urine tenofovir assay) and reduced CMD symptoms (SRQ\u201020&lt;7) at Week 12 and, secondarily, Week 4. We used Poisson regression to assess intervention effects and summarized responses to three validated scales assessing intervention acceptability, appropriateness and feasibility (ranges: 1\u20134).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 116 AGYW enrolled, the median SRQ\u201020 score was 9. We retained 69% through Week 12. Of 57 intervention participants, 64.9% (<jats:italic>N<\/jats:italic> = 37) received four or more sessions. At Week 4, 29\/36 (80.6%) participants in the intervention and 25\/41 (61.0%) in the standard\u2010of\u2010care had recent PrEP use (RR = 1.40; 95% CI = 1.03\u22121.89; <jats:italic>p<\/jats:italic> = 0.03), but this was not sustained through Week 12 (RR = 0.88; 95% CI = 0.64\u22121.22; <jats:italic>p<\/jats:italic> = 0.44). Enrolment SRQ\u201020 score was not associated with Week 12 PrEP adherence or retention. CMD symptoms did not differ by arm at Week 4 or 12, although the proportion with SRQ\u201020 scores &gt;7 decreased overall between Weeks 4 (54.5%, 42\/77) and 12 (35.0%, 28\/80; <jats:italic>p<\/jats:italic> = 0.02). Median acceptability, appropriateness and feasibility scores were 3.50, 3.75 and 3.25, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The intervention improved PrEP adherence at Week 4, although the effect was not durable to Week 12, possibly due to retention challenges. Reductions in CMD symptoms were seen in both arms. Findings suggest different mental health and PrEP support interventions may be needed to improve integrated service delivery among AGYW.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.70037","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T06:00:38Z","timestamp":1756965638000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Combining HIV prevention Options with Mental health service delivery for Adolescent girls and young women (CHOMA): results of a pilot hybrid effectiveness\u2010implementation randomized trial in South Africa"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7242-7415","authenticated-orcid":false,"given":"Jennifer","family":"Velloza","sequence":"first","affiliation":[{"name":"Department of Epidemiology &amp; Biostatistics University of California San Francisco  San Francisco California USA"},{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6168-7008","authenticated-orcid":false,"given":"Nomhle","family":"Ndimande\u2010Khoza","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Mills","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6675-6241","authenticated-orcid":false,"given":"Nicole","family":"Poovan","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliza","family":"Adler","sequence":"additional","affiliation":[{"name":"Department of Epidemiology &amp; Biostatistics University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth B.","family":"Sherwin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology &amp; Biostatistics University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie","family":"Mathew","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zinhle","family":"Sokhela","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5959-1891","authenticated-orcid":false,"given":"Ruth","family":"Verhey","sequence":"additional","affiliation":[{"name":"Friendship Bench Program  Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dixon","family":"Chibanda","sequence":"additional","affiliation":[{"name":"Friendship Bench Program  Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7025-1994","authenticated-orcid":false,"given":"Monica","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8813-3419","authenticated-orcid":false,"given":"Connie","family":"Celum","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"},{"name":"Department of Medicine University of Washington  Seattle Washington USA"},{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0376-1019","authenticated-orcid":false,"given":"Sinead","family":"Delany\u2010Moretlwe","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0269317"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31288-7"},{"key":"e_1_2_15_4_1","unstructured":"UNAIDS.Trend in new infections: Eastern Southern Western Central Africa by sex. 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