The primary outcome is total body less-head bone mineral content for lean mass adjusted for height (TBLH-BMC LBM) Z-score at 48 weeks, measured by dual-energy X-ray absorptiometry (DEXA). Eight hundred and forty children living with HIV aged 11-19 years taking ART for ≥6 months will be enrolled and followed up for 96 weeks. We will conduct an individually randomised, double-blinded, placebo-controlled trial of weekly high-dose vitamin D 3 (20,000 IU) plus daily calcium carbonate (500mg) supplementation for 48 weeks. This trial aims to establish whether supplementation with vitamin D 3 and calcium carbonate improves musculoskeletal health among peripubertal children living with HIV. Vitamin D deficiency, which is highly prevalent among children living with HIV in sub-Saharan Africa, has a further adverse impact on bone health. Despite antiretroviral therapy, longstanding HIV infection is associated with several chronic complications in children including growth failure, particularly stunting and delayed puberty. Of the 2 million children living with HIV globally, 90% live in sub-Saharan Africa.
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