Comparing Youth-Friendly Health Services to the Standard of Care Through “Girl Power-Malawi”: A Quasi-Experimental Cohort Study

Rosenberg, Nora E.; Bhushan, Nivedita L.; Vansia, Dhrutika; Phanga, Twambilile; Maseko, Bertha; Nthani, Tiyamike; Libale, Colleta; Bamuya, Catherine; Kamtsendero, Linda; Kachigamba, Annie; Myers, Laura J.; Tang, Jennifer H.; Hosseinipour, Mina C.; Bekker, Linda‐Gail; Pettifor, Audrey

doi:10.1097/qai.0000000000001830

Cited by 54 publications

(55 citation statements)

References 19 publications

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“…Notwithstanding contributing influencers and barriers to scaling up a tested intervention model, scaling-up efforts must always be accompanied with research documenting planning and implementation processes, health-related outcomes, and impact to communicate lessons learned and opportunities for strengthening scale-up. 32,34 Study findings are largely consistent with existing literature, [5][6][7][8][9][10][11][13][14][15] indicating that mobilizing financial resources and quality of care are of paramount importance for effective scale-up and sustainability of interventions that aim to improve RH outcomes among adolescents and youth nationally. In other words, support for adolescent and youth RH was on paper, but there was limited financial allocation.…”

Section: Discussionsupporting

confidence: 81%

Scaling Up a Strengthened Youth-Friendly Service Delivery Model to Include Long-Acting Reversible Contraceptives in Ethiopia: A Mixed Methods Retrospective Assessment

Fikree¹,

Zerihun

2019

Int J Health Policy Manag

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Background: Donor funded projects are small scale and time limited, with gains that soon dissipate when donor funds end. This paper presents findings that sought to understand successes, challenges and barriers that influence the scaling up and sustainability of a tested, strengthened youth-friendly service (YFS) delivery model providing an expanded contraceptive method choice in one location – the YFS unit – with additional units in Amhara and Tigray, Ethiopia. Methods: This retrospective mixed methods study included interviews with key informants (KIs) (qualitative arm) and analysis of family planning (FP) uptake statistics extracted from the sampled health facilities (quantitative arm). A multistage convenience purposive sampling technique was adopted to randomly select 8 health facilities aligned with respective woredas, zones and regional health bureaus (RHBs). A semi-structured interview guide soliciting information on 6 scaling-up elements (stakeholder engagement, roles and responsibility, policy environment, financial resources, quality of voluntary FP services and data availability and use) guided the interviews. Fifty-six KI interviews were conducted with policy-makers, program managers, and clinic staff. Recurring themes were triangulated across administrative levels and implementing partners. Relevant FP data (acceptor status, age and method uptake) were extracted from the 8 sampled health facilities for a thirteen-month period. Qualitative findings triangulated with FP service statistics assessed the influence of the 6 scaling-up elements with trends in long-acting reversible contraceptive (LARC) uptake before and after training. Results: Our findings depict that respondents were knowledgeable and supportive of an expanded method mix. Statistically significant increases in long-acting contraceptive uptake were noted at 2 of the 8 health centers. Fidelity to the tested model was operationally constrained; respondents frequently mentioned trained staff absences and turnover as obstacles in offering quality FP services. Conclusion: Despite conducive policy environment, supportive stakeholders, favorable environment, and financial support for trainings, statistically significant increases in LARC uptake occurred at only 2 of the 8 health centers; indicating the influence of weak health systems, poor quality of voluntary FP services and a ceiling effect. Scale-up processes must consider potential bottlenecks of weak health systems and availability of financial resources by addressing these as crucial elements in any systematic scale-up framework.

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Section: Discussionsupporting

confidence: 81%

Scaling Up a Strengthened Youth-Friendly Service Delivery Model to Include Long-Acting Reversible Contraceptives in Ethiopia: A Mixed Methods Retrospective Assessment

Fikree¹,

Zerihun

2019

Int J Health Policy Manag

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“…Several HIVST strategies integrated HIV self-testing services with sexual and reproductive health services for youth. This nding is consistent with a larger literature underlining the importance of integrating HIV testing services and sexual/reproductive health services [33][34][35][36][37]. In these other contexts, HIV testing service had been embedded within family planning, STI testing, and sexual health counseling services.…”

Section: Discussionsupporting

confidence: 88%

A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event

Tahlil

Obiezu-Umeh

Gbajabiamila

et al. 2020

Preprint

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Background Youth are at high risk for HIV, but are often left out of designing interventions, including those focused on adolescents. We organized a designathon for Nigerian youth to develop HIV self-testing (HIVST) strategies for potential implementation in their local communities. A designathon is a problem-focused event where participants work together over a short period to create and present solutions to a judging panel. Methods We organized a 72-hour designathon for youth (14–24 years old) in Nigeria to design strategies to increase youth HIVST uptake. Proposals included details about HIVST kit service delivery, method of distribution, promotional strategy, and youth audience. Teams pitched their proposals to a diverse seven-member judging panel who scored proposals based on desirability, feasibility, potential impact and teamwork. We examined participants’ socio-demographic characteristics and summarized themes from their HIVST proposals. Results Forty-two youth on 13 teams participated in the designathon. The median team size was 3 participants (IQR: 2–4). The median age was 22.5 years (IQR: 21–24), 66.7% were male, 47.4% completed tertiary education, and 50% lived in Lagos State. Themes from proposals included HIVST integration with other health services, digital marketing and distribution approaches, and engaging students. Judges identified seven teams with exceptional HIVST proposals and five teams were supported for further training. Conclusions The designathon provided a structured method for incorporating youth ideas into HIV service delivery. This approach could differentiate HIV services to be more youth-friendly in Nigeria and other settings.

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“…Increasing numbers of PrEP users and wordof-mouth information about PrEP created local pockets of PrEP awareness among AGYW in our study settings which may have influenced stigma and disclosure experiences [20,48,49]. Expanding efforts to create demand around PrEP and integrate PrEP within primary care and sexual and reproductive health services in both countries also gained traction during the study period and will likely continue to increase awareness and acceptability of PrEP [50][51][52][53].…”

Section: Discussionmentioning

confidence: 99%

The influence of HIV‐related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study

et al. 2020

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Introduction Stigma and disclosure concerns have been key barriers to oral pre‐exposure prophylaxis (PrEP) adherence for African adolescent girls and young women (AGYW) in efficacy trials. We aimed to understand the impact of these factors among African AGYW in an open‐label PrEP study. Methods HPTN 082 was an open‐label PrEP study among AGYW (ages 16 to 24) in Harare, Zimbabwe, and Cape Town and Johannesburg, South Africa from 2016 to 2018. Women starting PrEP were randomized to standard adherence support (counselling, two‐way SMS, monthly adherence clubs) or standard support plus drug‐level feedback. Serial in‐depth interviews were conducted among 67 AGYW after 13‐week and 26‐week study visits to explore experiences of stigma, disclosure and PrEP adherence. We analysed data by coding transcripts and memo‐writing and diagramming to summarize themes. Results AGYW described stigma related to sexual activity (e.g. “people say I'm a prostitute”) and being perceived to be living with HIV because of taking antiretrovirals (e.g. “my husband's friends say I'm HIV infected”). Participants who anticipated stigma were reluctant to disclose PrEP use and reported adherence challenges. Disclosure also resulted in stigmatizing experiences. Across all sites, negative descriptions of stigma and disclosure challenges were more common in the first interview. In the second interview, participants often described disclosure as an “empowering” way to combat community‐level PrEP stigma; many said that they proactively discussed PrEP in their communities (e.g. became a “community PrEP ambassador”), which improved their ability to take PrEP and encourage others to use PrEP. These empowering disclosure experiences were facilitated by ongoing HPTN 082 study activities (e.g. counselling sessions, adherence clubs) in which they could discuss PrEP‐related stigma, disclosure and PrEP adherence issues. Conclusions Stigma and disclosure challenges were initial concerns for African AGYW newly initiating PrEP but many were empowered to disclose PrEP use over their first six months of PrEP use, which helped them cope with stigma and feel more able to take PrEP regularly. PrEP programmes can foster disclosure through community and clinic‐based discussion, adherence clubs and activities normalizing sexual behaviour and PrEP use, which can reduce stigma and improve PrEP adherence and thus effectiveness.

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Comparing Youth-Friendly Health Services to the Standard of Care Through “Girl Power-Malawi”: A Quasi-Experimental Cohort Study

Abstract: A YFHS model led to higher health service use. Implementation science is needed to guide scale-up.

Cited by 54 publications

References 19 publications

Scaling Up a Strengthened Youth-Friendly Service Delivery Model to Include Long-Acting Reversible Contraceptives in Ethiopia: A Mixed Methods Retrospective Assessment

Scaling Up a Strengthened Youth-Friendly Service Delivery Model to Include Long-Acting Reversible Contraceptives in Ethiopia: A Mixed Methods Retrospective Assessment

A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event

The influence of HIV‐related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study

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