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Comparing Youth-Friendly Health Services to the Standard of Care Through “Girl Power-Malawi”

A Quasi-Experimental Cohort Study

Rosenberg, Nora E., PhD, MSPH*,†; Bhushan, Nivedita L., MA*,†; Vansia, Dhrutika, MPH*; Phanga, Twambilile, MA*; Maseko, Bertha, BS*; Nthani, Tiyamike, BS*; Libale, Colleta, BS*; Bamuya, Catherine, BS*; Kamtsendero, Linda, BS*; Kachigamba, Annie, BS; Myers, Laura, MSW§; Tang, Jennifer, MD, MPH*,†; Hosseinipour, Mina C., MD, MPH*,†; Bekker, Linda-Gail, PhD, MBChB, DTMH, DCH, FCP(SA)§; Pettifor, Audrey E., PhD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1, 2018 - Volume 79 - Issue 4 - p 458–466
doi: 10.1097/QAI.0000000000001830
Implementation Science

Background: Adolescent girls and young women (AGYW) face challenges to seeking HIV and sexual and reproductive health services in sub-Saharan Africa. Integrated approaches designed for AGYW may facilitate service uptake, but rigorous evaluation is needed.

Methods: Four comparable public-sector health centers were selected in Malawi and randomly assigned to a service delivery model. One offered “standard of care” (SOC), consisting of vertical HIV testing, family planning, and sexually transmitted infection management in adult-oriented spaces, by providers without extra training. Three offered youth-friendly health services (YFHS), consisting of the same SOC services in integrated youth-dedicated spaces and staffed by youth-friendly peers and providers. In each health center, AGYW aged 15–24 years were enrolled and followed over 12 months to determine use of HIV testing, condoms, and hormonal contraception. The SOC and YFHS models were compared using adjusted risk differences and incidence rate ratios.

Findings: In 2016, 1000 AGYW enrolled (N = 250/health center). Median age was 19 years (interquartile range = 17–21 years). Compared with AGYW in the SOC, those in the YFHS models were 23% [confidence interval (CI): 16% to 29%)] more likely to receive HIV testing, 57% (CI: 51% to 63%) more likely to receive condoms, and 39% (CI: 34% to 45%) more likely to receive hormonal contraception. Compared with AGYW in the SOC, AGYW in the YFHS models accessed HIV testing 2.4 (CI: 1.9 to 2.9) times more, condoms 7.9 (CI: 6.0 to 10.5) times more, and hormonal contraception 6.0 (CI: 4.2 to 8.7) times more.

Conclusions: A YFHS model led to higher health service use. Implementation science is needed to guide scale-up.

*University of North Carolina Project, Lilongwe, Malawi;

University of North Carolina, Chapel Hill, Chapel Hill, NC;

Lilongwe District Health Office, Lilongwe, Malawi; and

§Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.

Correspondence to: Nora E. Rosenberg, PhD, MSPH, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440 (e-mail: Nora_Rosenberg@unc.edu).

Supported by Evidence for HIV Prevention in Southern Africa (EHPSA), a DFID program managed by Mott MacDonald. N.E.R. is funded by the National Institute of Mental Health (R00 MH104154) and through the UNC Center for AIDS Research from the National Institute of Allergies and Infectious Diseases (P30 AI50410). N.L.B. was supported by the National Institutes of Health Fogarty International Center (R25TW009340).

The authors have no funding or conflicts of interest to disclose.

Received March 17, 2018

Accepted June 18, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.