Uptake of HIV testing among adolescents and associated adolescent-friendly services

Abstract

Background HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact. Methods The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents’ uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services. Results Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexually-active adolescents. Conclusions We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence.

Engaging young people in the design of a sexual reproductive health intervention: Lessons learnt from the Yathu Yathu (“For us, by us”) formative study in Zambia

“…Similar to our study findings, other studies have shown that AYP prefer to access services in community-based spaces compared to the health facility [33,34]. A systematic review of interventions to prevent unintended and repeat pregnancy among young people in low and middle-income countries found that out of seven interventions that had a positive impact on contraceptive use, five were community-based [20].…”

Prevalence of HIV testing and associated factors among young adolescents in Eswatini: a secondary data analysis

“…The AFHS was defined as an evidence-based and specialized approach to addressing health system barriers and catering to developmental needs by providing a more accessible, acceptable, equitable, appropriate, and effective social environment for young people [ 38 ]. A recently published systematic review study supported that AFHS in health facilities and clinical settings positively influenced health service utilization for HIV testing and other sexually transmitted diseases or performing preventive behaviors in Sub-Saharan Arica [ 39 ]. However, there is a lack of understanding and limited knowledge in the literature regarding implementing appropriate strategies for delivering AFHS to help young adolescents receive HIV testing in resource-constrained out-of-facility settings [ 39 ].…”

Implementation Science for the Prevention and Treatment of HIV among Adolescents and Young Adults in Sub-Saharan Africa: A Scoping Review

“…3). For institutions within SSA, which accounted for 41.1% [44] of total author affiliations, South Africa singularly represented 38.6% [17] of these affiliations. The East African region represented 47.7% [21] affiliations, and West Africa and Central Africa represented 11.4% [5] and 2.3% [1], respectively.…”