Strengthening adolescent agency for optimal health outcomes

Vijayaraghavan, Janani; Vidyarthi, Ajita; Livesey, Alana; Gittings, Lesley; Levy, Marcy; Timilsina, Amit; Mullings, Danielle; Armstrong, Christopher J.

doi:10.1136/bmj-2021-069484

Cited by 9 publications

(9 citation statements)

References 24 publications

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“…Similar results have been found in many other studies from 60 countries that focus on sexual and reproductive health and HIV/AIDS programmes 50–53. These studies emphasise the importance of incorporating agency building into health programmes to enhance health outcomes, especially in environments where harmful norms and gender restrictions limit agency, particularly among women and young people 54…”

Section: Discussionsupporting

confidence: 84%

Understanding why and how youth-friendly health services improve viral load suppression among adolescents and young people living with HIV in Nigeria: realist evaluation with qualitative comparative analysis

Badejo,

Nöstlinger,

Wouters

et al. 2023

BMJ Glob Health

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IntroductionYouth-friendly health service (YFHS) approaches are essential to better outcomes for young people. We evaluated attainment of viral load suppression among young people living with HIV (YPLHIV) enrolled in an HIV treatment programme implementing YFHS models in Nigeria.MethodsA realist evaluation using qualitative and quantitative programme data from 10 implementing health facilities. We used qualitative information to explore how and why viral load suppression was attained across different settings and quantitative data to describe patterns and associations between youth-friendly structures and processes of care, care retention and viral load suppression. To consolidate the theories, we used qualitative comparative analysis to identify the necessary and sufficient conditions for attaining viral load suppression, using 30 YPLHIV as cases.ResultsBetween baseline (2018) and study-end (May 2022), viral load suppression coverage increased in 8 of the 10 study facilities. The number of facilities with viral load suppression coverage ≥90% rose from two to seven, while one facility remained unchanged, and another had a decline in coverage. Among the 30 selected YPLHIV cases, 18 had viral load suppression during the first test and 24 at the second test. However, viral load suppression attainment varied in different contexts. We identified the different YFHS interventions and key mechanisms that influenced viral load suppression in different contexts.ConclusionYFHS interventions can improve young people’s engagement with HIV services, but their effectiveness depends on specific mechanisms and contextual factors influencing their response to interventions. By exploring how and why viral load suppression was attained in different contexts, the findings will improve the design and implementation of strategies to improve outcomes in young people, which will be relevant for achievement of global goals to eliminate HIV by 2030.

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Section: Discussionsupporting

confidence: 84%

Understanding why and how youth-friendly health services improve viral load suppression among adolescents and young people living with HIV in Nigeria: realist evaluation with qualitative comparative analysis

Badejo,

Nöstlinger,

Wouters

et al. 2023

BMJ Glob Health

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“…This theme relates to having ownership over one’s self-management, based on factual and experiential knowledge that facilitates meaningful choices in life. Agency embodies the dynamic and complex nature of personal development construct through self-negotiation 59,60 during the transition to self-management of T1DM, specifically the significant differences in management decisions and practices by adolescents, their families, and health care professionals. This reflects on adolescents’ key decision-making and problem-solving abilities that personalize and enhance the transition from parental management so they may direct their self-management, a process that is intuitive and gradually learned.…”

Section: Resultsmentioning

confidence: 99%

Adolescents’ Experiences of Transition to Self-Management of Type 1 Diabetes: Systematic Review and Future Directions

Leocadio,

Kelleher,

Fernández

et al. 2023

The Science of Diabetes Self-Management and Care

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Purpose: The purpose of this systematic literature review was to explore studies that report the experiences of adolescents, their families, and health care professionals of adolescents’ transition to self-management of type 1 diabetes (T1DM). Methods: SocINDEX, PsycInfo, APA PsycArticles, and MEDLINE electronic databases were searched. Studies reporting on experiences of transition to self-management of T1DM for adolescents, their parents, siblings, and health care professionals published between January 2010 amd December 2021 were included. The Mixed Methods Appraisal Tool guided trustworthiness and relevance of selected studies. Results: A total of 29 studies met the inclusion criteria. Findings indicate that adolescents’ experiences of transitioning to self-management of T1DM are interconnected with the supports provided by others (eg, family, teachers, friends). Considering interdependence and collective lived experiences is essential to developing effective and personalized family, peer, and social interventions to facilitate transition and to avoid negative outcomes in later life. The renegotiation of roles within the network of supports that impact adolescents’ transition and adolescents’ self-negotiation have been neglected. Conclusion: Transition to self-management of T1DM is a dynamic and iterative process comprising of continuous shifts between interdependence and independence, making it challenging for all involved. A number of research gaps and avenues for future research are outlined.

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“…Notably, although AYA in the "consent and proximity" and "low-risk perception" classes share similar sociodemographic characteristics, they exhibit markedly different sexual behaviours and HIV infection odds, suggesting that they may represent divergent vulnerability patterns within the same AYA subgroup. Implementing interventions that promote autonomy among young people at an early stage of their development can create a favourable environment for positive transitions from the "consent and proximity" profile to the "low-risk perception" profile [ 58 , 59 ]. This transition increases the likelihood of adopting the "low-risk perception" profile, characterised by sexual activity that reduces vulnerability to HIV.…”

Section: Discussionmentioning

confidence: 99%

Latent class analysis of barriers to HIV testing services and associations with sexual behaviour and HIV status among adolescents and young adults in Nigeria

Badejo,

Wouters,

Van Belle

et al. 2024

PLoS ONE

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Introduction Adolescents and young adults (AYA) face multiple barriers to accessing healthcare services, which can interact, creating complex needs that often impact health behaviours, leading to increased vulnerability to HIV. We aimed to identify distinct AYA subgroups based on patterns of barriers to HIV testing services and assess the association between these barrier patterns and sexual behaviour, socio-demographics, and HIV status. Methods Data were from Nigeria’s AIDS Indicator and Impact Survey (NAIIS, 2018) and included 18,612 sexually active AYA aged 15–24 years who had never been tested for HIV and reported barriers to accessing HIV testing services. A Latent class analysis (LCA) model was built from 12 self-reported barrier types to identify distinct subgroups of AYA based on barrier patterns. Latent class regressions (LCR) were conducted to compare the socio-demographics, sexual behaviour, and HIV status across identified AYA subgroups. Sex behaviour characteristics include intergenerational sex, transactional sex, multiple sex partners, condom use, and knowledge of partner’s HIV status. Results Our LCA model identified four distinct AYA subgroups termed ’low-risk perception’ (n = 7,361; 39.5%), ’consent and proximity’ (n = 5,163; 27.74%), ’testing site’ (n = 4,996; 26.84%), and ’cost and logistics’ (n = 1,092; 5.87%). Compared to adolescents and young adults (AYA) in the low-risk perception class, those in the consent and proximity class were more likely to report engaging in intergenerational sex (aOR 1.17, 95% CI 1.02–1.35), transactional sex (aOR 1.50, 95% CI 1.23–1.84), and have multiple sex partners (aOR 1.75, 95% CI 1.39–2.20), while being less likely to report condom use (aOR 0.79, 95% CI 0.63–0.99). AYA in the testing site class were more likely to report intergenerational sex (aOR 1.21, 95% CI 1.04–1.39) and transactional sex (aOR 1.53, 95% CI 1.26–1.85). AYA in the cost and logistics class were more likely to engage in transactional sex (aOR 2.12, 95% CI 1.58–2.84) and less likely to report condom use (aOR 0.58, 95% CI 0.34–0.98). There was no significant relationship between barrier subgroup membership and HIV status. However, being female, aged 15–24 years, married or cohabiting, residing in the Southsouth zone, and of Christian religion increased the likelihood of being HIV infected. Conclusions Patterns of barriers to HIV testing are linked with differences in sexual behaviour and sociodemographic profiles among AYA, with the latter driving differences in HIV status. Findings can improve combination healthcare packages aimed at simultaneously addressing multiple barriers and determinants of vulnerability to HIV among AYA.

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Strengthening adolescent agency for optimal health outcomes

Cited by 9 publications

References 24 publications

Understanding why and how youth-friendly health services improve viral load suppression among adolescents and young people living with HIV in Nigeria: realist evaluation with qualitative comparative analysis

Understanding why and how youth-friendly health services improve viral load suppression among adolescents and young people living with HIV in Nigeria: realist evaluation with qualitative comparative analysis

Adolescents’ Experiences of Transition to Self-Management of Type 1 Diabetes: Systematic Review and Future Directions

Latent class analysis of barriers to HIV testing services and associations with sexual behaviour and HIV status among adolescents and young adults in Nigeria

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