Perspectives of Adolescent Girls and Young Women on Optimizing Youth-Friendly HIV and Sexual and Reproductive Health Care in Zambia.

Patrick V Edwards,Sujha Subramanian,Michael Mbizvo,Lyson Phiri,Caila Brander,Drosin Mulenga,Nachela Chelwa,Sarah T Roberts,Maurice Musheke,Laura Nyblade

doi:10.3389/fgwh.2021.723620

Abstract

Youth-friendly health care delivery models are needed to address the complex health care needs of adolescent girls and young women (AGYW). The aim of this study is to explore the lived experiences of AGYW seeking comprehensive HIV and sexual and reproductive health (SRH) care and to elicit their preferences for integrated health care services. We conducted in-depth interviews and focus group discussions in Lusaka, Zambia among 69 AGYW aged 10-20 who were HIV-negative or of unknown status and 40 AGYW aged 16-24 living with HIV. The data were coded through deductive and inductive processes and analyzed thematically using modified World Health Organization (WHO) dimensions of quality for youth-friendly services. AGYW expressed preference for one-stop clinics with integrated services that could provide HIV services along with other services such as pregnancy testing and family planning. AGYW also wanted information on staying healthy and approaches to prevent disease which could be delivered in the community setting such as youth clubs. An integrated clinic should address important attributes to AGYW including short wait time, flexible opening hours, assurance of confidentiality and positive staff attitudes. Youth-friendly, integrated care delivery models that incorporate AGYW preferences may foster linkages to care and improve outcomes among vulnerable AGYW.

Highlights

Youth-friendly health services that target adolescent girls and young women (AGYW) affected by HIV are urgently needed in sub-Saharan Africa
Themes relating to clinic preferences were largely common across both HIV-/u AGYW and YLHIV and key differences that emerged between these groups are specified
This study identified several defining attributes of a youthfriendly, integrated health care delivery model based on clinic experiences and preferences of AGYWs in Lusaka, Zambia

Summary

Introduction

Youth-friendly health services that target adolescent girls and young women (AGYW) affected by HIV are urgently needed in sub-Saharan Africa. Prior studies in sub-Saharan Africa attribute low adolescent engagement with HIV clinics to issues including stigma and the fear of privacy loss [6,7,8] Another recent study documented significant challenges with antenatal care, noting that young pregnant women in Zambia lacked a youth-specific space and experienced poor provider attitudes and long wait time for consultations [9]. In response to these challenges and in an effort to achieve the global HIV 95-95-95 targets, the Zambian government established a national adolescent health strategy in 2017 mandating the provision of youth-friendly services and is encouraging evaluations of new care delivery models for AGYW that support the “Test and Start” approach, which prioritizes improving HIV testing and treatment through enhancing linkages to, and retention in, care [10,11,12,13,14]

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