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// ─── helpers ───────────────────────────────────────────────────────────────
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// ─── Title page ────────────────────────────────────────────────────────────
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  new Paragraph({
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      text: 'RESEARCH PROPOSAL',
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      text: 'Drug Compliance, Immunological Status, and Psychosocial\nChallenges Among HIV-Positive Patients Below 21 Years in Zambia',
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      text: 'Despite Existing Interventions Including Child-Friendly Corners\nand Other Support Programmes',
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// ─── Executive Summary ─────────────────────────────────────────────────────
const execSummary = [
  heading1('EXECUTIVE SUMMARY'),
  para(
    'HIV remains one of the most significant public health challenges in Zambia, with an estimated 1.5 million people living with HIV and a disproportionate burden falling on children and adolescents who acquired the virus perinatally. While antiretroviral therapy (ART) is freely available through the public health system, drug compliance among patients below 21 years remains alarmingly poor - with viral suppression rates dropping from over 70% in pre-adolescence to as low as 40-50% during late adolescence and young adulthood.'
  ),
  para(
    'The Zambian government and its partners have deployed several targeted interventions to address this gap, including Child-Friendly Corners (CFCs) within health facilities, psychosocial support clubs, peer mentorship programmes, and differentiated service delivery models. Despite these efforts, adherence gaps persist, opportunistic infections continue to occur in this age group, and psychosocial distress - including stigma, depression, and behavioural disengagement - remains poorly characterised at a population level in Zambia.'
  ),
  para(
    'This study proposes a mixed-methods cross-sectional investigation of drug compliance, immunological outcomes (CD4 count), and psychosocial factors among 200 HIV-positive patients aged 10-21 years attending ART clinics in Lusaka Province. By generating robust local evidence on why existing interventions are falling short for this specific cohort, this research will directly inform programme redesign, policy advocacy, and targeted investment - making it a high-value, high-impact use of research funding.'
  ),
  new Paragraph({ children: [new PageBreak()] }),
];

// ─── Section 1: Background & Rationale ────────────────────────────────────
const background = [
  heading1('1. BACKGROUND AND RATIONALE'),
  heading2('1.1 The HIV Burden Among Zambian Youth'),
  para(
    'Zambia carries one of the highest HIV burdens in sub-Saharan Africa. The 2021-2022 Zambia Population-based HIV Impact Assessment (ZAMPHIA) estimates overall HIV prevalence at 11.1%, with approximately 44,000 new infections occurring annually. Children and adolescents represent a substantial share of people living with HIV (PLHIV), many of whom were perinatally infected and have been on ART for most of their lives.'
  ),
  para(
    'Global data consistently show that adolescents living with HIV (ALHIV) have worse treatment outcomes than both younger children and adults. Viral suppression rates decline sharply as children enter adolescence: studies in Zambia and neighbouring countries document a fall from approximately 70% in childhood to 37-50% in adolescence. This decline coincides with the transition from paediatric to adult care, increasing autonomy without adequate preparation, and heightened psychosocial stressors unique to this developmental stage.'
  ),
  heading2('1.2 What Current Interventions Offer - and Where They Fall Short'),
  para(
    'The Zambian Ministry of Health, PEPFAR, UNICEF, and numerous NGOs have invested heavily in adolescent-responsive HIV services. Key interventions include:'
  ),
  bulletPara('Child-Friendly Corners (CFCs): Dedicated clinic spaces designed to be welcoming, age-appropriate, and supportive for children and adolescents. CFCs aim to reduce stigma, encourage engagement in care, and provide peer interaction.'),
  bulletPara('Adolescent Support Clubs (ASCs): Group-based peer support platforms that meet regularly to discuss adherence, stigma, disclosure, and psychosocial wellness.'),
  bulletPara('Peer Mentorship Programmes: Trained older ALHIV serve as mentors, providing role modelling, counselling, and adherence support.'),
  bulletPara('Differentiated Service Delivery (DSD): Flexible appointment scheduling, community ART groups, and facility-based fast-track services designed to reduce clinic burden and improve retention.'),
  bulletPara('Psychological First Aid and Counselling: Trained counsellors within HIV care settings offering disclosure support, grief counselling, and mental health referrals.'),
  para(
    'Despite this investment, viral non-suppression and ART non-adherence persist. A 2022 systematic review (Chem et al., J Int AIDS Soc) found that adolescents in sub-Saharan Africa consistently report unmet needs related to mental health, sexual and reproductive health, and psychosocial support - even within programmes that nominally address these areas. A 2021 meta-analysis (Laurenzi et al., J Int AIDS Soc) confirmed that while psychosocial interventions improve engagement in care, effect sizes are modest and highly variable, suggesting that the specific ingredients that work for a given context remain unclear.'
  ),
  para(
    'Critically, there is a persistent evidence gap: very few studies have simultaneously measured drug compliance, immunological markers (CD4 count and viral load), and the psychosocial profile of ALHIV in Zambia while accounting for the presence or absence of specific support interventions like CFCs. Without this triangulated evidence, programme managers cannot determine which interventions are working, for whom, and why.'
  ),
  heading2('1.3 The Zambia-Specific Evidence Gap'),
  para(
    'Most published data on ALHIV adherence in Zambia come from single-facility studies or programme evaluations limited to one type of intervention (e.g., Project YES! in Ndola, which tested peer mentorship alone). There is no recent multi-facility study covering Lusaka Province that maps drug compliance against immunological outcomes and psychosocial determinants in patients aged 10-21 years, while also documenting their exposure to existing support programmes such as CFCs. This gap means that:'
  ),
  bulletPara('Programme planners lack the evidence to know whether CFCs and similar interventions are reaching the most vulnerable within this age group.'),
  bulletPara('Clinicians cannot identify the psychosocial subgroups at highest risk of non-adherence and immunological deterioration.'),
  bulletPara('Policymakers cannot justify targeted reallocation of resources toward the most effective components of the adolescent HIV care package.'),
  para(
    'This study is designed to fill that gap directly and produce actionable, context-specific evidence for Zambia.'
  ),
  new Paragraph({ children: [new PageBreak()] }),
];

// ─── Section 2: Problem Statement ─────────────────────────────────────────
const problem = [
  heading1('2. PROBLEM STATEMENT'),
  para(
    'Despite free access to ART and the existence of targeted psychosocial interventions including Child-Friendly Corners, adolescent support clubs, and peer mentorship programmes, many HIV-positive patients below 21 years born with HIV in Zambia continue to demonstrate poor drug compliance. This non-adherence results in suboptimal CD4 counts, increased viral load, heightened susceptibility to opportunistic infections, and deteriorating quality of life.'
  ),
  para(
    'Beyond biological consequences, these patients experience significant psychosocial burden: mood disorders (depression and anxiety), internalised stigma, behavioural disengagement from care, and negative attitudes toward long-term ART use. The convergence of these biological and psychosocial factors creates a cycle in which poor adherence worsens immunological status, which in turn amplifies psychological distress and further undermines adherence.'
  ),
  para(
    'The core problem is not the absence of interventions - Zambia has invested substantially in adolescent-responsive HIV services. The problem is that the existing interventions have not been sufficiently studied in their combined effect on drug compliance, immunological markers, and psychosocial well-being within this specific age group in Lusaka Province. Without this evidence, the persistent adherence gap cannot be closed.'
  ),
  new Paragraph({ children: [new PageBreak()] }),
];

// ─── Section 3: Why This Study Must Be Funded ─────────────────────────────
const whyFund = [
  heading1('3. WHY THIS STUDY MUST BE FUNDED: THE CASE FOR INVESTMENT'),
  para(
    'This section directly addresses the funding organisation\'s central question: Why should resources be committed to this study, given that interventions already exist?'
  ),
  heading2('3.1 Existing Interventions Are Necessary But Not Sufficient'),
  para(
    'Child-Friendly Corners and related programmes represent important structural investments. However, structural availability does not equal effective utilisation or meaningful impact on adherence. A CFC that is physically present in a clinic but fails to address the specific psychosocial drivers affecting a 16-year-old who has been on ART since birth is not delivering its intended benefit. Funding this study will establish, for the first time in Lusaka, whether ALHIV who access CFCs and support clubs achieve measurably better drug compliance and CD4 outcomes than those who do not - and why or why not.'
  ),
  heading2('3.2 The Cost of Inaction Outweighs the Cost of Research'),
  para(
    'Every adolescent who is non-adherent to ART faces a compounding clinical and economic cost: more opportunistic infections requiring hospitalisation, faster progression to AIDS-defining illness, possible development of drug-resistant viral strains, and eventual loss of first-line ART efficacy. In Zambia, second- and third-line ART regimens are substantially more expensive and less accessible. Investing in research that identifies the modifiable drivers of non-adherence is far less costly than managing the downstream consequences of treatment failure at scale.'
  ),
  heading2('3.3 This Study Generates Evidence That Directly Drives Programme Reform'),
  para(
    'The study is designed not merely to describe the problem but to produce actionable, decision-ready evidence. Specifically:'
  ),
  bulletPara('Quantitative data on compliance rates and CD4 correlations will allow health facilities to benchmark their adolescent populations and set measurable improvement targets.'),
  bulletPara('Qualitative data from focus groups and in-depth interviews will uncover the specific barriers - stigma, disclosure fears, caregiver fatigue, peer pressure, transition anxieties - that structured questionnaires often miss.'),
  bulletPara('By mapping these findings against participants\' documented exposure to CFCs and support programmes, we will produce the first Lusaka-level analysis of whether these interventions are reaching and benefiting the most adherence-vulnerable adolescents.'),
  heading2('3.4 The Study Is Positioned Within a Critical Policy Window'),
  para(
    'Zambia is currently implementing its National HIV/AIDS Strategic Framework and aligning with UNAIDS 95-95-95 targets. The third 95 - 95% of those on treatment achieving viral suppression - remains the hardest to reach, and adolescents represent the largest unmet portion of that gap. Funding this study now means results will be available to inform the next cycle of national programme planning and donor reporting, maximising policy relevance and impact.'
  ),
  heading2('3.5 Adolescents Living With Perinatally Acquired HIV Are a Uniquely Neglected Cohort'),
  para(
    'Most global ART adherence research focuses on adult PLHIV. Adolescents who acquired HIV perinatally - and who have lived with the virus since birth - face a distinct psychological reality: HIV is not an event that happened to them, it is an identity they have always carried. The experience of lifelong treatment fatigue, involuntary disclosure risk, and the transition from parent-managed to self-managed ART creates adherence challenges that adult-focused models do not capture. This study explicitly centres this neglected cohort and will generate findings that are generalisable to similar settings across sub-Saharan Africa.'
  ),
  heading2('3.6 Strong Preliminary Evidence Base Supports Feasibility and Impact'),
  para(
    'This proposal builds on a solid published evidence base. A 2021 meta-analysis by Laurenzi et al. (PMID: 34338417) confirmed that psychosocial interventions improve engagement in HIV care among ALHIV but noted that effect sizes vary widely and context matters. A 2022 systematic review by Chem et al. (PMID: 35983685) identified unmet health-related needs among ALHIV in sub-Saharan Africa - including mental health support, counselling, and age-appropriate information - that go beyond what current interventions provide. Local Zambia data from Ndola (FHI360 dissemination brief) show that stigma, peer pressure, lack of status disclosure, and caregiver involvement remain critical barriers. This study extends and deepens that evidence base in a new geographic setting with a broader methodological approach.'
  ),
  new Paragraph({ children: [new PageBreak()] }),
];

// ─── Section 4: Objectives ─────────────────────────────────────────────────
const objectives = [
  heading1('4. RESEARCH OBJECTIVES'),
  heading2('4.1 General Objective'),
  para(
    'To investigate the relationship between drug compliance, immunological status (CD4 count), mood changes, and behavioural attitudes toward HIV among patients below 21 years born with HIV in Zambia, in the context of existing support interventions including Child-Friendly Corners and adolescent support programmes.'
  ),
  heading2('4.2 Specific Objectives'),
  bulletPara('To assess the level of drug compliance among HIV-positive patients aged 10-21 years attending ART clinics in Lusaka Province.'),
  bulletPara('To determine the correlation between drug compliance and CD4 count levels in this population.'),
  bulletPara('To explore mood changes, psychosocial distress, and behavioural attitudes toward HIV and ART in this cohort.'),
  bulletPara('To identify barriers to adherence and unmet psychosocial support needs, including barriers that existing interventions (CFCs, support clubs) do not adequately address.'),
  bulletPara('To assess the utilisation and perceived effectiveness of current support interventions (including Child-Friendly Corners) among participants.'),
  bulletPara('To recommend evidence-based strategies for improving adherence and psychosocial well-being in this population.'),
  new Paragraph({ children: [new PageBreak()] }),
];

// ─── Section 5: Research Questions ─────────────────────────────────────────
const researchQs = [
  heading1('5. RESEARCH QUESTIONS'),
  boldPara('RQ1: ', 'What is the level of drug compliance among HIV-positive patients below 21 years born with HIV in Lusaka Province, Zambia?'),
  boldPara('RQ2: ', 'What is the relationship between drug compliance and CD4 count levels in this population?'),
  boldPara('RQ3: ', 'What mood changes and behavioural attitudes toward HIV and ART are prevalent among these patients?'),
  boldPara('RQ4: ', 'What individual, family, social, and health system-level factors contribute to poor ART adherence in this cohort?'),
  boldPara('RQ5: ', 'To what extent are existing interventions (Child-Friendly Corners, peer support clubs, counselling) being accessed and perceived as effective by adolescent patients?'),
  boldPara('RQ6: ', 'What specific programmatic and policy changes are recommended to address the gaps identified?'),
  new Paragraph({ children: [new PageBreak()] }),
];

// ─── Section 6: Methodology ─────────────────────────────────────────────────
const methodology = [
  heading1('6. METHODOLOGY'),
  heading2('6.1 Study Design'),
  para(
    'A mixed-methods cross-sectional study combining quantitative and qualitative approaches. The quantitative strand will establish the prevalence and correlates of poor adherence and suboptimal CD4 outcomes. The qualitative strand will explore the lived experiences, psychosocial contexts, and perceived barriers that underlie these patterns. Integration of both strands will produce a more complete and actionable picture than either approach alone.'
  ),
  heading2('6.2 Study Setting'),
  para(
    'ART clinics in Lusaka Province, Zambia. Lusaka Province was selected due to: (i) its high HIV burden and large adolescent HIV caseload; (ii) the presence of Child-Friendly Corners and active adolescent support programmes in multiple health facilities; and (iii) the feasibility of multi-site data collection.'
  ),
  heading2('6.3 Study Population and Eligibility'),
  boldPara('Inclusion: ', 'HIV-positive patients aged 10-21 years; perinatal HIV acquisition confirmed in clinical records; currently enrolled in ART care at a participating facility; able to provide informed assent/consent (and guardian consent for minors).'),
  boldPara('Exclusion: ', 'Patients with severe cognitive impairment precluding participation; newly initiated on ART (less than 6 months) as adherence patterns are not yet established; patients in acute medical crisis at the time of data collection.'),
  heading2('6.4 Sample Size'),
  para(
    'Approximately 200 participants for the quantitative component, determined using the Kish-Leslie formula for proportions, assuming 50% drug compliance prevalence (the most conservative estimate), 95% confidence level, 5% margin of error, and a design effect of 1.5 to account for multi-site clustering. For the qualitative component, 4-6 focus group discussions (6-10 participants each) and 20-30 in-depth interviews will be conducted, with sample size guided by thematic saturation.'
  ),
  heading2('6.5 Sampling Strategy'),
  bulletPara('Quantitative: Systematic random sampling from facility-based ART registers at 4-5 selected Lusaka health facilities.'),
  bulletPara('Qualitative: Purposive sampling to ensure diversity of age (10-14, 15-17, 18-21 subgroups), sex, adherence status (good vs. poor), and exposure to CFC/support programmes.'),
  heading2('6.6 Data Collection Instruments'),
  boldPara('Structured Questionnaire: ', 'Covering socio-demographics, ART history, self-reported adherence (using the ACTG Adherence Questionnaire), knowledge of HIV status, disclosure status, caregiver involvement, and utilisation of support interventions.'),
  boldPara('Medical Record Review: ', 'Extraction of CD4 count data, viral load results (where available), ART regimen history, and clinic attendance records.'),
  boldPara('Validated Psychosocial Scales: ', 'Patient Health Questionnaire for Adolescents (PHQ-A) for depression screening; HIV Stigma Scale (adapted for adolescents); Rosenberg Self-Esteem Scale.'),
  boldPara('Focus Group Discussion Guide: ', 'Semi-structured guide exploring peer and family dynamics, stigma experiences, perceptions of CFCs and support clubs, and barriers to adherence.'),
  boldPara('In-Depth Interview Guide: ', 'For participants selected for deeper exploration, covering identity, treatment fatigue, transition experiences, and suggestions for programme improvement.'),
  heading2('6.7 Data Analysis'),
  boldPara('Quantitative: ', 'Data entered and cleaned in REDCap; analysed using SPSS v26. Descriptive statistics for compliance rates and CD4 distributions. Pearson/Spearman correlation and multivariable logistic regression to identify predictors of poor adherence and low CD4 count. Sub-group analyses by age band, sex, and CFC utilisation.'),
  boldPara('Qualitative: ', 'Transcripts transcribed verbatim (with back-translation where needed), entered into NVivo. Thematic analysis following Braun and Clarke\'s six-phase framework. Member checking and peer debriefing used to ensure trustworthiness.'),
  boldPara('Mixed Methods Integration: ', 'A joint display matrix will be used to integrate quantitative findings with qualitative themes, enabling direct comparison and identification of convergent, complementary, or discordant results.'),
  new Paragraph({ children: [new PageBreak()] }),
];

// ─── Section 7: Ethical Considerations ────────────────────────────────────
const ethics = [
  heading1('7. ETHICAL CONSIDERATIONS'),
  bulletPara('Ethical approval will be sought from the University of Zambia Biomedical Research Ethics Committee (UNZABREC) before any data collection begins.'),
  bulletPara('Written informed consent will be obtained from all participants aged 18 and above and from guardians of participants below 18. Adolescent assent will be obtained from all participants aged 10-17.'),
  bulletPara('Participation is entirely voluntary. Withdrawal at any time will not affect clinical care.'),
  bulletPara('All data will be de-identified prior to analysis. Paper records will be stored in a locked cabinet; electronic data will be password-protected and accessible only to the research team.'),
  bulletPara('Participants who disclose significant psychological distress during data collection will be referred to trained counsellors within the facility. A referral pathway will be established prior to data collection.'),
  bulletPara('Findings will be disseminated to participating facilities and the Ministry of Health to ensure research benefit flows back to the study communities.'),
  new Paragraph({ children: [new PageBreak()] }),
];

// ─── Section 8: Expected Outcomes and Impact ──────────────────────────────
const outcomes = [
  heading1('8. EXPECTED OUTCOMES AND IMPACT'),
  heading2('8.1 Research Outputs'),
  bulletPara('A quantitative profile of drug compliance rates and their correlation with CD4 counts among ALHIV aged 10-21 in Lusaka.'),
  bulletPara('A psychosocial profile identifying the prevalence of depression, stigma, and behavioural disengagement in this population.'),
  bulletPara('An assessment of Child-Friendly Corner and support programme utilisation rates and their association with adherence outcomes.'),
  bulletPara('A detailed analysis of barriers to adherence that existing interventions do not address.'),
  bulletPara('Evidence-based recommendations for programme reform, clinical protocol revision, and policy advocacy.'),
  heading2('8.2 Programmatic and Policy Impact'),
  bulletPara('Findings will be presented to the Zambia Ministry of Health\'s National HIV/AIDS/STI/TB Council (NAC) and relevant PEPFAR implementing partners to inform the next National HIV/AIDS Strategic Framework.'),
  bulletPara('The study will produce a policy brief for immediate use by facility managers and district health offices.'),
  bulletPara('Peer-reviewed publication will ensure findings contribute to the global evidence base on adolescent HIV care, with direct relevance to other high-burden sub-Saharan African countries.'),
  bulletPara('If specific components of CFCs or support programmes are shown to be ineffective for certain subgroups, this evidence will justify targeted programme redesign and resource reallocation.'),
  new Paragraph({ children: [new PageBreak()] }),
];

// ─── Section 9: Significance ──────────────────────────────────────────────
const significance = [
  heading1('9. SIGNIFICANCE OF THE STUDY'),
  para(
    'This study occupies a critical position at the intersection of clinical medicine, public health, and adolescent psychology. Its significance operates at multiple levels:'
  ),
  boldPara('Clinical significance: ', 'By identifying the psychosocial and behavioural predictors of poor ART adherence in perinatally infected adolescents, this study will equip clinicians with actionable screening tools and referral criteria to identify high-risk patients earlier.'),
  boldPara('Programmatic significance: ', 'By evaluating whether existing interventions (specifically Child-Friendly Corners and adolescent support programmes) translate into measurable adherence improvement, this study will answer the central programme management question: Are we getting value from these investments, and if not, what needs to change?'),
  boldPara('Policy significance: ', 'Zambia\'s commitment to the UNAIDS 95-95-95 targets cannot be met without dramatically improving viral suppression among adolescents. This study provides the Zambia-specific evidence needed to justify targeted policy action for this cohort.'),
  boldPara('Scientific significance: ', 'The mixed-methods triangulation approach - linking self-reported adherence, immunological biomarkers, and qualitative psychosocial data - produces a depth of evidence rarely achieved in single-method studies, and will contribute novel methodological insights to the global literature.'),
  para(
    'Most fundamentally, this study recognises that ALHIV in Zambia are not passive recipients of interventions - they are young people navigating a complex developmental transition while managing a lifelong condition with profound social consequences. Understanding their experience in full, and evaluating what support actually works for them, is both a scientific imperative and a moral obligation.'
  ),
  new Paragraph({ children: [new PageBreak()] }),
];

// ─── Section 10: Work Plan ─────────────────────────────────────────────────
const workplan = [
  heading1('10. WORK PLAN AND TIMELINE'),
  new Table({
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      ...[
        ['Preparation', 'Ethics submission; instrument development; staff recruitment and training; site preparation', 'Months 1-3'],
        ['Data Collection', 'Quantitative surveys; medical record review; focus group discussions; in-depth interviews', 'Months 4-7'],
        ['Data Analysis', 'Data cleaning; statistical analysis (SPSS); qualitative coding (NVivo); mixed-methods integration', 'Months 8-10'],
        ['Dissemination', 'Report writing; stakeholder workshops; policy brief; manuscript preparation and submission', 'Months 11-12'],
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// ─── Section 11: Budget (indicative) ──────────────────────────────────────
const budget = [
  heading1('11. INDICATIVE BUDGET'),
  new Table({
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      }),
      ...[
        ['Personnel', 'Research assistant salaries (2 x 12 months), data entry clerks, transcribers', '$18,000'],
        ['Training', 'Data collector training, ethical research workshop, qualitative methods training', '$3,500'],
        ['Data Collection', 'Printing of instruments, transport to field sites, participant refreshments', '$5,200'],
        ['Data Management', 'REDCap setup, NVivo license, SPSS license, secure data storage', '$3,000'],
        ['Dissemination', 'Stakeholder workshops, policy brief printing, open-access publication fees', '$4,500'],
        ['Indirect / Overhead', 'Institutional overhead (10%)', '$3,420'],
        ['Contingency', 'Unplanned costs (5%)', '$1,881'],
        ['TOTAL', '', '$39,501'],
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// ─── Section 12: References ────────────────────────────────────────────────
const references = [
  heading1('12. KEY REFERENCES'),
  para('1. Laurenzi CA, du Toit S, Ameyan W, et al. Psychosocial interventions for improving engagement in care and health and behavioural outcomes for adolescents and young people living with HIV: a systematic review and meta-analysis. J Int AIDS Soc. 2021;24(8):e25741. PMID: 34338417.'),
  para('2. Chem ED, Ferry A, Seeley J, et al. Health-related needs reported by adolescents living with HIV and receiving antiretroviral therapy in sub-Saharan Africa: a systematic literature review. J Int AIDS Soc. 2022;25(8):e25985. PMID: 35983685.'),
  para('3. Denison JA, Burke VM, Miti S, et al. Project YES! Youth Engaging for Success: a randomised controlled trial assessing the impact of a clinic-based peer mentoring programme on viral suppression, adherence and internalised stigma among HIV-positive youth (15-24 years) in Ndola, Zambia. PLoS One. 2020;15(4):e0232488.'),
  para('4. FHI360. Challenges and potential strategies for supporting adolescents living with HIV in Ndola, Zambia: Results from a study dissemination meeting. FHI360 Dissemination Brief; 2014.'),
  para('5. Zambia Ministry of Health. Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection. Lusaka: MoH; 2020.'),
  para('6. UNAIDS. Global AIDS Update 2023: The Path That Ends AIDS. Geneva: UNAIDS; 2023.'),
  para('7. PEPFAR. Adolescents and Youth Supplemental Guidance. Washington DC: PEPFAR; 2022.'),
  para('8. U.S. Department of Health and Human Services. Adherence to Antiretroviral Therapy in Children and Adolescents. Clinical Info HIV.gov; updated 2024.'),
];

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// ───────────────────────────────────────────────────────────────────────────
// SLIDE 3 – THE HIV CRISIS AMONG ZAMBIAN YOUTH (STATS)
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// ───────────────────────────────────────────────────────────────────────────
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// ───────────────────────────────────────────────────────────────────────────
// SLIDE 5 – THE EVIDENCE GAP (problem slide)
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// ───────────────────────────────────────────────────────────────────────────
// SLIDE 6 – SECTION DIVIDER: THE CASE FOR FUNDING
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// ───────────────────────────────────────────────────────────────────────────
// SLIDE 8 – PROBLEM STATEMENT
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// ───────────────────────────────────────────────────────────────────────────
// SLIDE 9 – OBJECTIVES
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    "Assess level of drug compliance among HIV-positive patients aged 10–21 years in Lusaka Province",
    "Determine the correlation between drug compliance and CD4 count levels",
    "Explore mood changes, psychosocial distress and behavioural attitudes toward HIV and ART",
    "Identify barriers to adherence not addressed by existing interventions (incl. CFCs)",
    "Evaluate utilisation and perceived effectiveness of Child-Friendly Corners and support programmes",
    "Recommend evidence-based strategies for improving adherence and psychosocial well-being",
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// ───────────────────────────────────────────────────────────────────────────
// SLIDE 10 – METHODOLOGY
// ───────────────────────────────────────────────────────────────────────────
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    "200 participants (Kish-Leslie formula, 95% CI, 5% margin)",
    "Systematic random sampling from ART registers across 4-5 Lusaka facilities",
    "ACTG Adherence Questionnaire (self-reported compliance)",
    "Medical record review: CD4 counts & viral load",
    "PHQ-A (depression), HIV Stigma Scale, Rosenberg Self-Esteem Scale",
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    "20–30 In-depth Interviews (purposive sampling)",
    "Sub-groups: age bands (10-14, 15-17, 18-21), sex, adherence status, CFC exposure",
    "Thematic analysis (Braun & Clarke 6-phase framework)",
    "NVivo software for coding and theme management",
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// ───────────────────────────────────────────────────────────────────────────
// SLIDE 11 – TIMELINE
// ───────────────────────────────────────────────────────────────────────────
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// ───────────────────────────────────────────────────────────────────────────
// SLIDE 12 – BUDGET
// ───────────────────────────────────────────────────────────────────────────
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    { item: "Personnel", desc: "2 research assistants (12 mo.), data entry clerks, transcribers", amt: "$18,000", pct: 46, col: C.blue },
    { item: "Data Collection", desc: "Instrument printing, transport, participant refreshments", amt: "$5,200",  pct: 13, col: C.teal },
    { item: "Training", desc: "Data collector training, ethical research, qualitative methods", amt: "$3,500",  pct: 9,  col: C.navy },
    { item: "Data Management", desc: "REDCap, NVivo, SPSS licenses, secure storage", amt: "$3,000",  pct: 8,  col: "8E44AD" },
    { item: "Dissemination", desc: "Stakeholder workshops, policy brief, open-access publication", amt: "$4,500",  pct: 11, col: C.gold },
    { item: "Overhead & Contingency", desc: "Institutional overhead (10%) + contingency (5%)", amt: "$5,301",  pct: 13, col: C.midGrey },
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// ───────────────────────────────────────────────────────────────────────────
// SLIDE 13 – EXPECTED IMPACT
// ───────────────────────────────────────────────────────────────────────────
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    { icon: "📊", type: "Programme", col: C.blue,  body: "First Lusaka-level evidence on whether CFCs translate into adherence improvement — enabling data-driven programme redesign" },
    { icon: "📋", type: "Policy",   col: C.teal,  body: "Zambia-specific data to justify targeted investment toward the adolescent 95-95-95 gap in the next National Strategic Framework" },
    { icon: "📚", type: "Science",  col: "8E44AD",body: "Mixed-methods triangulation (adherence + CD4 + psychosocial) produces novel insights for the global ALHIV research literature" },
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// ───────────────────────────────────────────────────────────────────────────
// SLIDE 14 – ETHICAL COMMITMENT
// ───────────────────────────────────────────────────────────────────────────
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    { icon: "📝", label: "Informed Consent", detail: "Written consent from adults (18+), guardian consent plus adolescent assent for all participants aged 10–17" },
    { icon: "🔒", label: "Data Privacy", detail: "De-identified datasets; paper records in locked storage; electronic data password-protected with restricted access" },
    { icon: "💚", label: "Participant Safety", detail: "Counsellor referral pathway pre-established for participants disclosing psychological distress during data collection" },
    { icon: "🔄", label: "Research Benefit", detail: "Findings fed back to participating facilities and the Ministry of Health to ensure communities benefit from the research" },
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// ───────────────────────────────────────────────────────────────────────────
// SLIDE 15 – CLOSING CALL TO ACTION
// ───────────────────────────────────────────────────────────────────────────
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    "Fund a rigorous study that measures what interventions actually deliver",
    "Generate the evidence that drives real programme and policy reform",
    "Invest in a neglected cohort — perinatally infected youth — who deserve dedicated science",
    "Help Zambia close the adolescent gap in its 95-95-95 commitments",
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// ───────────────────────────────────────────────────────────────────────────
// SAVE
// ───────────────────────────────────────────────────────────────────────────
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