Citation
Rosenberg, Nora E.; Bhushan, Nivedita L.; Vansia, Dhrutika; Phanga, Twambilile; Maseko, Bertha; Nthani, Tiyamike; Libale, Colleta; Bamuya, Catherine; Kamtsendero, Linda; & Kachigamba, Annie, et al. (2018). Comparing Youth Friendly Health Services to the Standard of Care through "Girl Power-Malawi": A Quasi-Experimental Cohort Study. Journal of Acquired Immune Deficiency Syndromes, 79(4), 458-466. PMCID: PMC6203606Abstract
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 15-24 years old 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 (inter-quartile range=17-21 years). Compared to AGYW in the SOC, those in the YFHS models were 23% (CI: 16%-29%) more likely to receive HIV testing, 57% (CI: 51%-63%) more likely to receive condoms, and 39% (CI: 34%-45%) more likely to receive hormonal contraception. Compared to AGYW in the SOC, AGYW in the YFHS models accessed HIV testing 2.4 (CI: 1.9-2.9) times more, condoms 7.9 (CI: 6.0-10.5) times more, and hormonal contraception 6.0 (CI: 4.2-8.7) times more.
CONCLUSION: A YFHS model led to higher health service use. Implementation science is needed to guide scale-up.
URL
http://dx.doi.org/10.1097/qai.0000000000001830Reference Type
Journal ArticleYear Published
2018Journal Title
Journal of Acquired Immune Deficiency SyndromesAuthor(s)
Rosenberg, Nora E.Bhushan, Nivedita L.
Vansia, Dhrutika
Phanga, Twambilile
Maseko, Bertha
Nthani, Tiyamike
Libale, Colleta
Bamuya, Catherine
Kamtsendero, Linda
Kachigamba, Annie
Myers, Laura
Tang, Jennifer H.
Hosseinipour, Mina C.
Bekker, Linda-Gail
Pettifor, Audrey E.