Abstract
BackgroundHIV 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.MethodsThe 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.ResultsMost 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.ConclusionsWe 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.
Highlights
It may be possible to increase uptake of vital services – such as HIV testing – by ensuring health facilities are in locations accessible to adolescents, are open after school hours, offer comprehensive sexual and reproductive health (SRH) services, ensure privacy, and are delivered in an adolescent-friendly manner by providers
This study describes the availability of Adolescentfriendly health services (AFHS), adolescents’ perception of care, and adolescents’ utilization of services in two rural regions of Tanzania
Over half the adolescents (971) reported a previous HIV test, with over a third (696) reporting that they had received a test in the past year
Summary
Making public health services more adolescent-friendly is one strategy used to encourage testing. It remains unclear whether government-led initiatives have a meaningfully impact. In the United Republic of Tanzania, for example, less than half of female youth with HIV infection are aware of their status [4]. It may be possible to increase uptake of vital services – such as HIV testing – by ensuring health facilities are in locations accessible to adolescents, are open after school hours, offer comprehensive sexual and reproductive health (SRH) services, ensure privacy, and are delivered in an adolescent-friendly manner by providers
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