Participants will be recruited from community-based HIV counselling and testing platforms established in study communities for the purpose of this study. Consent and enrolment will be conducted by field-based enrolment counsellors.

Two different CBCT modalities, pop-up site and home-based testing, will be leveraged in each community. HIV testing will be conducted in accordance with South African national guidelines [50]. Referrals to local HIV treatment services will be provided to those with a confirmed positive result.

Three pop-up testing sites will be leveraged in each study community. The main site (Site A) will be a fixed-positioned testing venue co-located with a centralized community venue for the full duration of the study. A second site (Site B) will be a semi-mobile container co-located with another recognizable community venue during enrolment. A third site (Site C) will be a highly mobile testing tent placed at peripheral locations in each community, and repositioned 2–3 times during enrolment.

Prior to initiating home-based testing activities, GIS maps will be obtained for each community, with 24 urban and 26 rural small-block areas delineated and individual houses plotted for targeted testing. Detailed maps and electronic tablets will be used to track the small-block areas and houses visited and tested. Home-based testing will be performed until all houses are visited at least once.

Prior to screening, participants will be asked to provide fingerprints to facilitate participant identification during subsequent study activities; fingerprints will be collected using the FS88 Futronic Fingerprint Scanner [Futronic Technology Company, Kwai Fong, Hong Kong]. Participants will then be asked to complete an audio computer-assisted self-interviewing (ACASI) questionnaire collecting socio-demographic, behavioural, and clinical histories; HIV knowledge, attitudes, and practice; and a self-reported HIV risk survey. Upon completing the ACASI, participants will watch a PrEP informational video [51], followed by an interviewer-administered screening tool to assess whether the participant is currently (1) interested in learning more about PrEP, (2) interested in taking PrEP, (3) using post-exposure prophylaxis (PEP), (4) participating in other HIV prevention studies, (5) pregnant, (6) breast feeding, (7) on TB treatment, or (8) has signs or symptoms of acute HIV infection. Responses will be captured in real time using REDCap.

A candidate is eligible for referral to PrEP initiation services if they (1) are aged 16–25 years; (2) self-identify as female; (3) have a HIV-negative test result obtained from a study-associated CBCT site; (4) plan on residing in the study community for at least 12 months; (5) complete the baseline questionnaire; (6) express interest in taking PrEP; (7) not taking TB treatment; (8) not pregnant or breastfeeding; (9) not currently using PEP; (10) not currently participating in other HIV prevention studies; (11) do not have signs or symptoms of acute HIV infection; (12) understand English or IsiXhosa. Of note, given the likelihood of social desirability bias, structural risk factors, and the dynamic nature of HIV risk among South African AGYW, prior sexual activity will not be used as inclusion/exclusion criterion [8, 52, 53].

Eligible participants interested in PrEP will be provided a copy of their HIV test results and a referral letter for PrEP initiation at our study sites, which will be co-located with pop-up testing sites A and B. Upon presenting to a PrEP study site, participants will be consented, asked to provide contact details, tested for syphilis and pregnancy, and asked to submit a self-collected vaginal swab for further STI testing (Table (Table2).2). If pregnant, participants will be provided a referral letter for antenatal care services in lieu of PrEP initiation, as South Africa has not yet approved PrEP initiation during pregnancy. Prior to departure, participants will receive their syphilis test results, with a treatment referral if applicable.

Participants will be asked to provide a blood sample for hepatitis B testing and creatinine clearance, randomized, and then provided a 30-day supply (1 bottle) of DIDIVIR (CIPLA generic for Emtricitabine 200 mg/ Tenofovir Disoproxil Fumarate 300 mg); those randomized to an intervention group will be reminded of their first adherence session date. All participants will be asked to return for an orientation visit 2 weeks post-enrolment to meet with their adherence counsellor, and a study nurse to review any test results, assess side effects and acute HIV symptoms, and receive the first of three hepatitis B injections if indicated.

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