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Background  Despite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa – especially among adolescents and young people. We used community-based participatory research (CBPR), informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in KwaZulu-Natal (KZN).    Methods  Between March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adap t  a biosocial peer-led intervention to support HIV prevention. Men and women aged 18–30 years were selected by community leaders of 21 intervention implementation areas ( izigodi ) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected during a 2016–2018 study into 17 vignettes illustrating the local drivers of HIV. During three participatory intervention development workshops and community mapping sessions, the peer-navigators critically engaged with vignettes, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change which, following a six-month pilot and process evaluation, the peer-navigators refined. The intervention will be evaluated in a randomised controlled trial ( NCT04532307 ).    Results  Following written and oral assessments, 57 of the 108 initially selected participated in two workshops to discuss the vignettes and co-create the  Thetha Nami  (`talk to me’). The intervention included   peer-led health promotion   to improve self-efficacy and demand for HIV prevention,   referrals to social and educational resources   ,  and   aaccessible youth-friendly clinical services   to improve uptake of HIV prevention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 were linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just “ onward referral ”. In the third participatory workshop 54 peer-navigators refined the  Thetha Nami  intervention to add three components:   structured assessment tool   to tailor health promotion and referrals,   safe spaces and community advocacy   to create an enabling environment, and   peer-mentorship and navigation   of resources to improve retention in HIV prevention.    Conclusion  Local youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12889-021-11399-z.

bmc public health

Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa