Implementation Strategies to Enhance Youth-Friendly Sexual and Reproductive Health Services in Sub-Saharan Africa: A Systematic Review

Abstract

Introduction: Youth-friendly health service (YFHS) interventions are a promising, cost-effective approaches to delivering sexual and reproductive services that cater to the developmental needs of young people. Despite a growing evidence-base, implementation of such interventions into practice have proven to be challenging in sub-Saharan Africa (SSA). Thus, the purpose of this review is to synthesize existing evidence on YFHS implementation in SSA and understand which implementation strategies were used, in what context, how they were used, and leading to which implementation outcomes.Methods: A comprehensive literature search in PubMed, Embase, Scopus, and CINAHL, was conducted to identify peer-reviewed research articles published from database inception up until August 2020. Eligible studies were required to include young people (ages 10–24 years) in sub-Saharan Africa. Studies that described implementation strategies, as conceptualized by the Expert Recommendations for Implementing Change (ERIC) project, used to enhance the implementation of YFHS were included. Implementation outcomes were extracted using Proctor and colleagues' 8 taxonomy of implementation outcomes.Results: We identified 18 unique interventions (reported in 23 articles) from an initial search of 630 articles, including seven from East Africa, seven from South Africa, and four from West Africa. In most studies (n = 15), youth-friendly health services were delivered within the context of a health facility or clinic setting. The most frequently reported categories of implementation strategies were to train and educate stakeholders (n = 16) followed by infrastructure change (n = 10), to engage consumers (n = 9), the use of evaluative and iterative strategies (n = 8), support clinicians (n = 8), and providing interactive assistance (n = 6). The effectiveness of the strategies to enhance YFHS implementation was commonly measured using adoption (n = 15), fidelity (n = 7), acceptability (n = 5), and penetration (n = 5). Few studies reported on sustainability (n = 2), appropriateness (n = 1), implementation cost (n = 1) and feasibility (n = 0).Conclusion: Results of the review emphasize the need for further research to evaluate and optimize implementation strategies for promoting the scale-up and sustainability of evidence-based, YFHS interventions in resource-constrained settings. This review also highlights the need to design robust studies to better understand which, in what combination, and in what context, can implementation strategies be used to effectively enhance the implementation of YFHS interventions.

“We Should Be Taught Self-Respect, Self-Confidence and Self-Love”: Youth Perspectives of Adult Influences on Their Sexuality and Relationships Among South African Adolescents Living With HIV

“…Existing quantitative (23,(43)(44)(45)(46) and qualitative (47-49) studies on adolescent SRH needs in SSA, such as this one, demonstrate the gaps in young people's access to information and resources related to SRH, and provide the basis for the argument that sexuality education must be provided to younger adolescents. Importantly, these findings confirm research from the past decade, highlighting the magnitude of work that remains to be done to more effectively address the SRH needs of ALHIV (42,(50)(51)(52). Recent interventions highlight the importance of family engagement (29, 51, 53), peer-based approaches including peer support groups (8,52), and newer ways of engaging youth, such as mHealth (30,43,49,54).…”

“…This theoretical framework provides practical insight into interventions likely to be effective with this group, simultaneously engaging youth and impactful adults in their support networks (10), and illustrating specific recommendations for mapping onto existing intervention approaches. Specifically, these interventions could take the form of mHealth or in-person interventions with parallel programming to simultaneously engage ALHIV, caregivers, and clinicians, targeting all levels of the socio-ecological framework (41,50,51,(53)(54)(55)(56). There is also a need for future interventions to focus on positive parenting around sexuality, integrated HIV and mental healthcare, communication and decision-making skillbuilding, and socially acceptable health education to encourage healthy sexual decision-making in ALHIV.…”

Psychosocial and mental health challenges faced by emerging adults living with HIV and support systems aiding their positive coping: a qualitative study from the Kenyan coast

“…For challenges that are unique to young adults living with HIV, a focused intervention approach is recommended. For instance, implementation of various youth-friendly sexual and reproductive health services [ 33 , 34 ] using strategies that work in SSA [ 33 ] can be a good avenue for these young adults to discuss about their future life goals at an individual level. Where feasible, transport support programmes to young adults living with HIV is encouraged to promote treatment adherence leading to better HIV outcomes.…”

“…Addressing them will need design and implementation of multi-level interventions in this or other similar settings. Such interventions should be youth friendly (like these sexual and reproductive health programmes [ 33 , 34 ]) and incorporate appropriate support systems for positive coping of these young adults. The multi-faceted challenges experienced by young adults living with HIV in our setting may interfere with brain development processes at the prefrontal cortex.…”

“…Addressing them will need design and implementation of multi-level interventions in this or other similar settings. Such interventions should be youth friendly (like these sexual and reproductive health programmes [ 33 , 34 ]) and incorporate appropriate support systems for positive coping of these young adults.…”