Youth Preferences for HIV Testing in South Africa: Findings from the Youth Action for Health (YA4H) Study Using a Discrete Choice Experiment

Chetty-Makkan, Candice M.; Hoffmann, Christopher J.; Charalambous, Salome; Botha, Claire; Ntshuntshe, Simphiwe; Nkosi, N.; Kim, Hae Young

doi:10.1007/s10461-020-02960-9

Cited by 10 publications

(8 citation statements)

References 40 publications

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“…Few studies have looked at preferences for SRH and HIV services among adolescents using the DCE method (13,35,37). Strauss et al (13) conducted an unlabelled DCE looking specifically at preferences for HIV counselling and Testing services in South Africa and Michaels-Igbokwe (35)looked at preferences for family planning in Malawi using a labelled DCE.…”

Section: Discussionmentioning

confidence: 99%

School-going learners are more likely to access HIV and contraceptive care at locations with friendly providers, Wi-Fi and other value-added services: Findings from a discrete choice experiment among learners in Gauteng, South Africa

Govathson

Long

Moolla

et al. 2022

Preprint

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Background: Many Adolescents in Sub-Saharan Africa do not access HIV and reproductive health services optimally. To improve uptake of these services, it is important to understand the students preferences for how services are delivered so that implementation strategies can reflect this. Methods: A discrete choice experiment (DCE) was used to elicit preferences. The DCE was conducted in 10 high schools situated in neighbourhoods of varying socioe-conomic status (SES) in Gauteng (South Africa). Students aged ≥15 years (Grades 9-12) were consented and enrolled in the DCE. Conditional logistic regression was used to determine preferred attributes for HIV and contraceptive service delivery. Results were stratified by gender and neighbourhood SES quintile. (1≡Lowest SES; 5≡Highest SES). Results: The DCE was completed between 07/2018-09/2019; 805 students were enrolled (67% female; 66% 15-17 years; 51% in grades 9-10). 54% of students in quintile 1 schools had no monthly income; 38% in quintile 5 schools had access to USD7 per month. Preferences were similar for male and female students. Students strongly preferred services provided by friendly, non-judgmental staff (Odds ratio 1.63; 95% Confidence Interval: 1.55-1.72) where confidentiality was ensured (1.33; 1.26-1.40). They preferred services offered after school (1.14; 1.04-1.25) with value-added services like free WiFi (1.19; 1.07-1.32), food (1.23; 1.11-1.37) and youth-only waiting areas (1.18; 1.07-1.32). Students did not have a specific location preference, but preferred not to receive services within the community (0.82; 0.74-0.91) or school (0.88; 0.80-0.96). Students attending schools in high SES neighbourhoods expressed a preference for private care (1.15; 0.98-1.35). Costs to access services were a deterrent for most students irrespective of school neighbourhood; female students were deterred by costs ≥USD3 (0.79; 0.70-0.91); males by costs ≥USD7 (0.86; 0.74-1.00) Conclusions: Preferences that encourage utilisation of services do not significantly differ by gender or school neighbourhood SES. Staff attitude and confidentiality are key issues affecting students decisions to access HIV and contraceptive services. Addressing how healthcare providers respond to young people seeking sexual

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Section: Discussionmentioning

confidence: 99%

School-going learners are more likely to access HIV and contraceptive care at locations with friendly providers, Wi-Fi and other value-added services: Findings from a discrete choice experiment among learners in Gauteng, South Africa

Govathson

Long

Moolla

et al. 2022

Preprint

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“…1 Department of Sociology, University of Cape Town, Cape Town, South Africa; 2 Universitas Hospital, Bloemfontein, South Africa; 3 Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; 4 Centre for Social Science Research, University of Cape Town, Cape Town, South Africa; 5 Department of Social Policy and Intervention, University of Oxford, Oxford, UK…”

Section: A U T H O R S ' a F F I L I At I O N Smentioning

confidence: 99%

“…Adolescents in South Africa are disproportionately affected by HIV [ 4 , 5 , 6 , 7 ], with lower achievement of the 95‐95‐95 HIV cascade [ 8 ]. South Africa is home to 20% of all ALHIV globally, with young women disproportionately affected [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Two years after lockdown: reviewing the effects of COVID‐19 on health services and support for adolescents living with HIV in South Africa

2022

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Introduction South Africa's progress towards the 95‐95‐95 goals has been significantly slower among adolescents living with HIV (ALHIV), among whom antiretroviral therapy (ART) adherence, retention in care and viral suppression remain a concern. After 2 years of living with COVID‐19, it is important to examine the direct and indirect effects of the pandemic on healthcare resources, access to HIV services and availability of support structures, to assess their impact on HIV care for ALHIV. Discussion The COVID‐19 response in South Africa has shifted healthcare resources towards combatting COVID‐19, affecting the quality and availability of HIV services—especially for vulnerable populations, such as ALHIV. The healthcare system's response to COVID‐19 has threatened to diminish fragile gains in engaging ALHIV with HIV services, especially as this group relies on overburdened public health facilities for their HIV care. Reallocation of limited health resources utilized by ALHIV disrupted healthcare workers’ capacity to form and maintain therapeutic relationships with ALHIV and monitor ALHIV for ART‐related side effects, treatment difficulties and mental health conditions, affecting their ability to retain ALHIV in HIV care. Prevailing declines in HIV surveillance meant missed opportunities to identify and manage opportunistic infections and HIV disease progression in adolescents. “Lockdown” restrictions have limited access to healthcare facilities and healthcare workers for ALHIV by reducing clinic appointments and limiting individual movement. ALHIV have had restricted access to social, psychological and educational support structures, including national feeding schemes. This limited access, coupled with reduced opportunities for routine maternal and sexual and reproductive health services, may place adolescent girls at greater risk of transactional sex, child marriages, unintended pregnancy and mother‐to‐child HIV transmission. Conclusions Adolescent HIV care in South Africa is often overlooked; however, ART adherence among ALHIV in South Africa is particularly susceptible to the consequences of a world transformed by COVID‐19. The current structures in place to support HIV testing, ART initiation and adherence have been reshaped by disruptions to health structures, new barriers to access health services and the limited available education and psychosocial support systems. Reflecting on these limitations can drive considerations for minimizing these barriers and retaining ALHIV in HIV care.

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“…For example, several studies indicate preference for and/or a higher uptake of HIV testing among youth research participants when offered at home compared with a health facility [ 42 , 43 , 44 ]. Conversely, a study among South African youth found no difference in youths’ preferences to receive an HIV test at home or in a clinic but either option was preferred compared with in a school [ 45 ]. Taken together, the implications of these mixed findings could be that for adolescent research participants, the quality of interpersonal interactions with providers during HIV testing and results disclosure may be more important than whether services are provided at home or at a clinic.…”

Section: Discussionmentioning

confidence: 99%

Does Venue of HIV Testing and Results Disclosure in the Context of a Research Study Affect Adolescent Health and Behavior? Results from a Study in Western Kenya

Luseno

Field

Iritani

et al. 2022

IJERPH

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Ethical concerns about risks to minor adolescents participating in HIV prevention research is a barrier to their inclusion. One concern is whether HIV testing and results disclosure venue affects the health and behavior of adolescent participants. We assessed for differential effects on quality of life (QOL), depressive symptoms, and sexual behavior due to (1) testing venue (home or health facility) and (2) test result (HIV-positive, HIV-negative, indeterminate). We collected data at three timepoints (baseline, 2-month follow-up, 12-month follow-up) from 113 Kenyan adolescents aged 15–19 (51% female). We analyzed the data using linear mixed effects models for the QOL and depressive symptoms outcomes and a logistic model for the sexual behavior outcome. Results showed a small mental health benefit for adolescents tested for HIV at a health facility compared with home. There was little evidence that testing venue influenced sexual behavior or that test results moderated the effects of HIV testing across all outcomes. The decision to conduct HIV testing at home or a health facility may not be very consequential for adolescents’ health and behavior. Findings underscore the need to critically examine assumptions about adolescent vulnerability to better promote responsible conduct of HIV prevention research with youth in sub-Saharan Africa.

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Youth Preferences for HIV Testing in South Africa: Findings from the Youth Action for Health (YA4H) Study Using a Discrete Choice Experiment

Cited by 10 publications

References 40 publications

School-going learners are more likely to access HIV and contraceptive care at locations with friendly providers, Wi-Fi and other value-added services: Findings from a discrete choice experiment among learners in Gauteng, South Africa

School-going learners are more likely to access HIV and contraceptive care at locations with friendly providers, Wi-Fi and other value-added services: Findings from a discrete choice experiment among learners in Gauteng, South Africa

Two years after lockdown: reviewing the effects of COVID‐19 on health services and support for adolescents living with HIV in South Africa

Does Venue of HIV Testing and Results Disclosure in the Context of a Research Study Affect Adolescent Health and Behavior? Results from a Study in Western Kenya

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