Mobile sexual health services for adolescents: investigating the acceptability of youth-directed mobile clinic services in Cape Town, South Africa

Abstract

Background The Human Immunodeficiency Virus (HIV) epidemic is growing rapidly among South African adolescents and young adults (AYA). Although HIV counselling and testing, HIV prevention and treatment options are widely available, many AYA delay health-seeking until illness occurs, demonstrating a need for youth responsive, integrated sexual and reproductive health services (SRHS). While feasibility and cost-effectiveness have been evaluated, acceptability of mobile clinics among AYA has yet to be established. The objective of this study was to investigate patient acceptability of mobile AYA SRHS and compare mobile clinic usage and HIV outcomes with nearby conventional clinics. Methods Patients presenting to a mobile clinic in Cape Town were invited to participate in an acceptability study of a mobile clinic after using the service. A trained researcher administered an acceptability questionnaire. Mobile clinic medical records during the study period were compared with the records of AYA attending four clinics in the same community. Results Three hundred three enrolled participants (16–24 years, 246 (81.2%) female) rated mobile AYA SRHS acceptability highly (median = 4,6 out of 5), with 90% rating their experience as better or much better than conventional clinics. The mobile clinic, compared to conventional clinics, attracted more men (26% v 13%, p < 0,000), younger patients (18 v 19 years, p < 0,000), and yielded more HIV diagnoses (4% v 2%, p < 0,000). Conclusions Given the high ratings of acceptability, and the preference for mobile clinics over conventional primary health clinics, the scalability of mobile clinics should be investigated as part of a multipronged approach to improve the uptake of SRHS diagnostic, prevention and treatment options for AYA. Electronic supplementary material The online version of this article (10.1186/s12913-019-4423-4) contains supplementary material, which is available to authorized users.

Reaching underserved South Africans with integrated chronic disease screening and mobile HIV counselling and testing: A retrospective, longitudinal study conducted in Cape Town

“…There is potential public health benefit in providing routine screening for these chronic diseases which are associated with disability and mortality. Since mobile clinics are cost-effective [ 39 ], have high levels of acceptability [ 41 ], and units can be directed to high disease burden areas, these may serve as effective diagnostic units that can offer earlier disease detection, associated with earlier treatment and care [ 12 , 19 ]. Subsequent disease management requires meticulous planning to ensure logistical support and follow-up for patients who require community-based care, and referral for those who may prefer more conventional care settings [ 69 ].…”

“…While the clinic could ensure confidentiality of patient medical records and privacy in the consultation room, the public nature of the clinic meant that patients’ attendance was visible. However, a recent study conducted with adolescents and young adults attending a mobile service showed that most (96%) rated the service as confidential [ 41 ]. Future research could investigate methods of providing HIV services that would increase uptake for those who are even harder to reach and for those who have reasons to avoid knowing their status.…”

“…Mobile clinic services are cost-effective [39] and have consistently been popular amongst populations who have lower levels of HCT at conventional facilities, including males and young people. Mobile services have the potential to provide rapid ART initiation [40] for underserved populations [32,[41][42][43]. Additionally, mobile diagnostic units can offer integrated services, which provide a convenient "one-stop" point-of-care screening and referral clinic [14].…”

A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa

“…Community-based mobile health clinics (CMHC) are an important model for delivering health services to vulnerable populations and impactful when providing differentiated, tailored and client-centered preventative health services [ 19 – 21 ]. In low- and middle-income countries, mobile health clinics have been deployed to provide a wide range of public health services; including cervical cancer screening in Thailand [ 22 ] and Brazil [ 23 ], maternal and child health care in Tanzania [ 24 ], primary health care in Namibia [ 25 ] and Malawi [ 26 ], mental health and diabetes screening and services in India [ 27 , 28 ], and HIV screening and sexual and reproductive health services in South Africa [ 29 , 30 ]. CMHC that provide comprehensive integrated SRHS may be especially attractive to AGYW, providing flexibility in location to increase accessibility for these populations in resource-limited settings.…”

Growing up with HIV

“…Our familiarity with HIV acts to bring it in line with a number of other youth-associated health concerns, such as diabetes and becoming pregnant, that may feel as, or sometimes more, concerning [12,15]. As a generation that is used to owning one mobile device that caters to a full spectrum of needs and an online portal that is simultaneously our library, shopping mall and social club, having our health needs separated into different visits, clinics and professionals seems odd and difficult to manage.…”