Posted: Jul 28, 2017
What Does Not Work in Adolescent Sexual and Reproductive Health: A Review of Evidence on Interventions Commonly Accepted as Best Practices
Youth centers, peer education, and one-off public meetings have generally been ineffective in facilitating young people’s access to sexual and reproductive health (SRH) services, changing their behaviors, or influencing social norms around adolescent SRH. Approaches that have been found to be effective when well implemented, such as comprehensive sexuality education and youth-friendly services, have tended to flounder as they have considerable implementation requirements that are seldom met. For adolescent SRH programs to be effective, we need substantial effort through coordinated and complementary approaches. Unproductive approaches should be abandoned, proven approaches should be implemented with adequate fidelity to those factors that ensure effectiveness, and new approaches should be explored, to include greater attention to prevention science, engagement of the private sector, and expanding access to a wider range of contraceptive methods that respond to adolescents’ needs.
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Posted: Jul 19, 2017
Preliminary results from Hlanganani (Coming Together): A structured support group for HIV-infected adolescents piloted in Cape Town, South Africa
HIV positive adolescents require unique physical and emotional care as they navigate not only developmental challenges but also HIV-related issues including stigma, prevention, and maintaining long-term HIV health. The Hlanganani Program was created to address these issues and engage adolescents in care using a dynamic, 3-session cognitive behavioral support group facilitated by laypersons. Youth 16 to 24 years old, diagnosed with-in the previous 12 months, were invited to attend three sessions in clinics or other community spaces. Topics in-cluded: 1.) Coping and support; 2.) HIV health (including CD4 counts and ARVs); and 3.) HIV prevention. (AYFS)
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SNYDER, K., WALLACE, M., DUBY, Z., AQUINO, L. D., STAFFORD, S., HOSEK, S., FUTTERMAN, D. & BEKKER, L.-G. 2014. Preliminary results from Hlanganani (Coming Together): A structured support group for HIV-infected adolescents piloted in Cape Town, South Africa. Children and Youth Services Review, 45, 114-121.
Posted: Feb 13, 2017
Improving HIV testing amongst adolescents through an integrated Youth Centre rewards program: Insights from South Africa
Despite high HIV prevalence the uptake of HIV counseling and testing (HCT) has been low in South African adolescents, in particular among boys. We designed and implemented an integrated Youth Centre (YC), which included a health clinic and a points based rewards program to incentivize YC services, adjacent to a peri-urban community in Cape Town. We compared 12 month age and gender speciﬁc HCT rates for 12–22 year olds between the YC and the single local community clinic in the adjacent community prospectively and for the 12 months prior to YC implementation. Local clinic data were collected through the HCT register. At the YC demographic, attendance, incentives and HIV testing data were prospectively collected via a biometric data collection system. 1187 12–22 year olds attended the YC in the 12 month period. Within the 12–15 year old age group, 12.7% more individuals tested at the YC compared to the clinic in 2011–2012; this difference was greater in males than females. In the 16–22 year category, signiﬁcantly more individuals tested at the clinic compared to the YC. The use of the YC reward program was associated with undergoing an HIV test. Understanding the speciﬁc programmatic factors that led to increased testing behaviour including the role of incentives at the YC warrants further attention.
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Posted: Feb 13, 2017
Barriers to and facilitators of the provision of a youth-friendly health services programme in rural South Africa
Background: Youth-friendly health services are a key strategy for improving young people’s health. This is the first study investigating provision of the Youth Friendly Services programme in South Africa since the national Department of Health took over its management in 2006. In a rural area of South Africa, we aimed to describe the characteristics of the publicly-funded primary healthcare facilities, investigate the proportion of facilities that provided the Youth Friendly Services programme and examine healthcare workers’ perceived barriers to and facilitators of the provision of youth-friendly health services.
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Methods: Semi-structured interviews were conducted with nurses of all eight publicly-funded primary healthcare facilities in Agincourt sub-district, Mpumalanga Province, South Africa. Thematic analysis of interview transcripts was conducted and data saturation was reached.
Results: Participants largely felt that the Youth Friendly Services programme was not implemented in their primary healthcare facilities, with the exception of one clinic. Barriers to provision reported by nurses were: lack of
youth-friendly training among staff and lack of a dedicated space for young people. Four of the eight facilities did not appear to uphold the right of young people aged 12 years and older to access healthcare independently. Breaches in young people’s confidentiality to parents were reported.
Conclusions: Participants reported that provision of the Youth Friendly Services programme is limited in this
sub-district, and below the Department of Health’s target that 70% of primary healthcare facilities should provide these services. Whilst a dedicated space for young people is unlikely to be feasible or necessary, all facilities have the potential to be youth-friendly in terms of staff attitudes and actions. Training and on-going support should be provided to facilitate this; the importance of such training is emphasised by staff. More than one member of staff per facility should be trained to allow for staff turnover. As one of a few countrywide, government-run youth-friendly clinic programmes in a low or middle-income country, these results may be of interest to programme managers and policy makers in such settings.
GEARY, R. S., GÓMEZ-OLIVÉ, F. X., KAHN, K., TOLLMAN, S. & NORRIS, S. A. 2014. Barriers to and facilitators of the provision of a youth-friendly health services programme in rural South Africa. BMC Health Services Research, 14, 259.
Posted: Jan 27, 2017
Effective Strategies to Provide Adolescent Sexual and Reproductive Health Services and to Increase Demand and Community Support
Access to youth friendly health services is vital for ensuring sexual and reproductive health (SRH) and well-being of adolescents. This study is a descriptive review of the effectiveness of initiatives to improve adolescent access to and utilization of sexual and reproductive health services (SRHS) in low- and middle-income countries. We examined four SRHS intervention types: (1) facility based, (2) out-of-facility based, (3) interventions to reach marginalized or vulnerable populations, (4) interventions to generate demand and/or community acceptance. Outcomes assessed across the four questions included uptake of SRHS or sexual and reproductive health commodities and sexual and reproductive health biologic outcomes. There is limited evidence to support the effectiveness of initiatives that simply provide adolescent friendliness training for health workers. Data are most ample (10 initiatives demon-strating weak but positive effects and one randomized controlled trial demonstrating strong positive results on some outcome measures) for approaches that use a combination of health worker training, adolescent-friendly facility improvements, and broad information dissemination via the community, schools, and mass media. We found a paucity of evidence on out-of-facility ebased strategies, except for those delivered through mixed-use youth centers that demonstrated that SRHS in these centers are neither well used nor effective at improving SRH outcomes. There was an absence of studies or evaluations examining outcomes among vulnerable or marginalized adolescents. Findings from 17 of 21 initiatives assessing demand-generation activities demonstrated at least some association with adolescent SRHS use. Of 15 studies on parental and other community gatekeepers’ approval of SRHS for adolescents, which assessed SRHS/commodity uptake and/or biologic outcomes, 11 showed positive results. Packages of interventions that train health workers, improve facility adolescent friendliness, and endeavor to generate demand through multiple channels are ready for large-scale implementation. However, further evaluation of these initiatives is needed to clarify mechanisms and impact, especially of speciﬁc program components. Quality research is needed to determine effective means to deliver services outside the facilities, to reach marginalized or vulnerable adolescents, and to determine effective approaches to increase community acceptance of adolescent SRHS.
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Denno DM, Hoopes AJ, Chandra-Mouli V. Effective Strategies to Provide Adolescent Sexual and Reproductive Health Services and to Increase Demand and Community Support. Journal of Adolescent Health.56(1):S22-S41.