SRH Services Research Articles

Using Andersen's Behavioral Model of Health Care Utilization to Assess Contraceptive Use among Sexually Active Perinatally HIV-Infected Adolescents in Uganda.

Background Contraceptive practices of perinatally HIV-infected adolescents (PHIAs) have implications related to pregnancy prevention, risks of HIV heterosexual transmission, reinfection, and vertical transmission. The study assessed contraceptive use among sexually active PHIAs in Uganda. Methods Mixed methods consisting of a survey and in-depth interviews were employed among 213 sexually active PHIAs who were attending antiretroviral therapy (ART) clinics. The study was guided by Andersen's Behavioral Model of Health Service Use as a theoretical framework to identify factors that influence contraceptive use. These factors include health care factors, personal characteristics, enabling factors, and needs. The outcome was contraceptive use. Multivariable logistic regression was used to establish determinants of contraceptive use. Qualitative data were analyzed by thematic analysis. Results Most PHIAs were female (67.6%); the mean (SD) and median (IQR) age was 17.5 (±1.4) and 18 (17-19) years. The mean age of sexual debut and at marriage were 15 (±1.7) and 17 (±1.1), respectively. Condoms were the most known method of family planning (indicated by 55.4%). Only 16.9% of the participants knew about dual protection (condom use for FP as well as HIV/STI prevention). Of the PHIAs, 43.6% had ever used modern contraception and 56.9% of the females had ever been pregnant. The odds of contraceptive ever-use were significantly higher among adolescents aged 17-19 years (OR 5.1, 95% CI: 2.1-13.3) compared to those aged 10-16 years, those in school (OR 1.8, 95% CI: 1.07-3.2) compared to those out of school, and those with perceived need to use FP (OR 2.0, 95% CI: 1.1-3.9) compared to their counterparts. The odds of contraceptive used were lower among females (OR 0.13, 95% CI: 0.06-0.28) compared to males. From the in-depth interviews, the attitude of health workers, availability of health workers, having a friend using family planning, and waiting time were viewed to affect contraceptive use. Conclusion Contraceptive use among sexually active perinatally HIV-infected adolescents was (43.6%). However, out of those who used family planning majority were using short-term methods. The unmet need for family planning was high (47%) with high reports of pregnancy (56.9%). The factors associated with contraceptive use included education, age, sex (predisposing factors), and perceived need of family planning (need factors). Other factors that could affect contraceptive use from qualitative analysis included attitude of health workers, availability of health workers, having a friend using family planning (predisposing factors), and waiting time (health system factors). HIV care for adolescents should be promoted using SRH approach. There is a need to provide training for all providers to cater for SRH services. We should continue to provide youth-responsive adolescent sexual and reproductive health services across all ART facilities and build a supportive environment and continue to integrate SRH services into HIV care.

Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health in Nepal.

The national lockdown imposed in Nepal as a response to the COVID-19 pandemic is having indirect consequences on sexual and reproductive (SRH) in Nepal. Although the Government of Nepal and partners have committed to ensuring the continuity of SRH services during the pandemic, this comment aims to illustrate the potential impacts to SRH if these commitments are not met. Keywords: COVID-19; Nepal; reproductive health; sexual health.

Adolescents living with HIV, complex needs and resilience in Blantyre, Malawi

BackgroundAdolescents living with HIV (ALHIV) in Malawi experience multiple challenges associated with their illness and various social, environmental, economic and cultural factors. In exploring their various medical concerns and social vulnerabilities, we consider the role of multiple services in creating a pathway for resilience.MethodsMultiple methods and case studies allowed for triangulation of evidence and provided a holistic understanding of resilience among adolescents with complex needs. The research methods included: (1) a survey to identify examples of young people with complex needs, (2) qualitative interviews and field notes to further explore these needs, (3) patient files and health passports to identify clinical challenges, and (4) ecomapping exercises to personalize cases and identify resilience-enabling resources and supports. We present four case studies to highlight the complex experiences and access to services of ALHIV, and to illustrate their growing power and decision-making capacity over time.ResultsAdversity experienced by ALHIV varied by gender, family situation, years of schooling, and use of teen-clubs for support. The two female adolescents emphasised their need to be accepted and how this impacted sexuality and reproduction. The two males illustrated how ideas of masculinity influenced their sexual practice and involvement with health services and the correctional justice system. Multiple risks (alcohol use, sexual activities) and complex needs (belonging, having a purpose in life/productive activities, autonomy, desire for offspring) influence pathways to resilience. ALHIV were able to strengthen their own wellbeing by resisting negative behaviours and peer pressure and caregiver interactions through ‘strategic silence’.ConclusionALHIV experienced self-transformation as a result of taking ART, with fewer severe episodes of illness and distressing skin conditions. Continuous engagement at the teen-club clinic transformed both productive activities and social relationships among ALHIV as they set life goals, gained a sense of empowerment, requested SRH services, and formed intimate relationships. These transformative opportunities allowed them to learn ways of minimizing risk of reinfection and violence, and of navigating health worker–caregiver–adolescent interactions.

Challenges Facing Tanzanian Youth in the Fight Against HIV/AIDS: Lessons Learnt from Mbeya Region, Southern Highlands

Globally, a major agenda in health and development has been HIV/AIDS mitigation measures among the youth. This follows the prevalence of sexual activity at a younger age, a burgeoning youth population that does not attend school and high unemployment that seems to push youth into alternative life patterns that involve risks to their health. Young people in Tanzania are more exposed to HIV/AIDS due to multiple factors, ranging from lack of SRH knowledge, to socio-cultural issues and poverty. Despite the fact that all people are susceptible to HIV transmission, youth – especially girls – are at the highest risk due to gender imbalances that prevent them from having support and decision-making power. Whereas numerous studies have concentrated on urban settings through a quantitative approach, this study investigated a wide-range of socio-cultural and gender related issues in rural and urban settings of Mbeya region, through a qualitative approach. The study involved 54 respondents. Qualitative data collection techniques included in-depth interviews, focus group discussions, and document review. The findings show that the majority of youth had heard about HIV/AIDS and its related effects; however, condom use, and attendance at SRH services was low. The challenges contributing to HIV/AIDS prevalence amongst youth include: lack of decision-making power; drug and alcohol abuse; inappropriate information about HIV/AIDS and SRH; and, household poverty. The study concludes that youth should be better incorporated in addressing the HIV/AIDS epidemic, and the Tanzanian government should create a supportive environment to access youth use of SRH services and more effective implementation of its policies.

Sexual and reproductive health and rights for all in Southeast Asia: more than SDGs aspirations

The Sustainable Development Goals (SDGs) and the proclaimed vision of leaving no one behind are lauded for their transformative potential in redressing inequalities. Yet, too few are interrogations of the root causes and underpinning structures that keep uneven development in place. This paper reflects on this omission in relation to sexual and reproductive health and rights (SRHR) drawing on over three decades of professional experience in advancing SRHR enriched by literature sources. Engaging with the theme of the 9th Asia-Pacific Sexual and Reproductive Health and Rights Conference – Leave NO ONE Behind! Justice in Sexual and Reproductive Health, it asks what it would take to realise the pledge of universal access to SRH services and rights. With a focus on Southeast Asia, the paper offers an account of context-specific drivers of disparity and exclusion that preclude the attainment of comprehensive SRHR for all, and especially for stigmatised and marginalised groups. It then discusses the paradigm shift that needs to occur if the ideals of inclusiveness and equity as promised by the SDGs are to be attained in and through SRHR.

Acceptability of artificial intelligence (AI)-enabled chatbots, video consultations and live webchats as online platforms for sexual health advice

ObjectivesSexual and reproductive health (SRH) services are undergoing a digital transformation. This study explored the acceptability of three digital services, (i) video consultations via Skype, (ii) live webchats with a...

Determinants of adolescent sexual and reproductive health service quality in Ghana

Aim: The aim of this study was to assess the determinants of SRH service quality among adolescents. Methods This study was a cross-sectional survey of four adolescent health facilities in the Tema Metropolis, Ghana. Structured questionnaire was administered to 420 adolescent clients. Data were analyzed with the aid of Statistical Package for Social Science (SPSS) software, version 23.0. Results were presented using univariate, bivariate and multivariate analyses. Results Majority (69.0%) of the respondents were females and students (62.0%), with a mean age of 16 years. It was found that of the five (5) quality of care dimensions, four dimensions were significantly associated with overall perception of quality. These include provider attitudes (β= .234, p< .05); facility characteristics (β= .128, p< .05); appropriateness of services (β= .108, p< .05); and health literacy (β= .208, p< .05). However, equity and non-discrimination had no significant association with overall perception of quality of care. Conclusion Adolescents perceived quality of SRH services to be good. Adolescents’ perceptions were influenced by positive provider attitudes, availability of age-appropriate sexual and reproductive health services, friendly hospital environment and availability of sexual and reproductive health information. This study sends a strong message to stakeholders who have an interest in adolescent health, well-being and development.

Barriers of Asian Youth to Access Sexual Reproductive Health Information and Services: A Literature Review

Background Despite recommendations from the World Health Organization in most Asian countries, people’s and health (SRH) needs are poorly provided and understood. The aim of this review paper is identifying barriers as well as improving strategies to access SRH information and services among Asian youth. Materials and Methods We conducted a review study and the databases used to search for articles include: Web of Science, Scopus, Medline, EMBASE, and the Cochrane Library, WHO, UNFPA, and UNESCO. The search terms sexual health, reproductive health, reproductive health service, information, knowledge, education, barrier, challenge, strategy, promotion were used and combined with Asian, adolescent, teenager, and young people. In this study we sought both qualitative and quantitative articles published between Jan 2008 and Jan 2019. Results Limited knowledge on SRH among youth, lack of youth friendly services, socio-cultural, legal, policy, leadership and political factors were the main obstacles of Asian youth to access SRH information and services. Culturally sensitive community based intervention, involving religious and social leaders, reforming health services and policies, considering integration of refugee youth’s SRH needs into policy of local governments in Asian critical areas and use of new media for distribution of information were identified as effective strategies for improving youth SRH. Conclusion Socio-cultural and structural barriers are the most important challenge of Asian youth to access health services. Restructuring health system and polices, culturally appropriate sex education are required to improve youth access to SRH services.

Women\u2019s costs for accessing comprehensive sexual and reproductive health services: findings from an observational study in Johannesburg, South Africa

BackgroundEvaluating progress towards the Sustainable Development Goal of universal access to sexual and reproductive (SRH) services requires an understanding of the health needs of individuals and what constitutes access to services. We explored women’s costs of accessing SRH services in Johannesburg, South Africa and contextualized costs based on estimates of household income.MethodsWe conducted an observational study of women aged 18–49 at a public HIV treatment site and two public primary health care facilities from June 2015 to August 2016. Interviews assessed women’s SRH needs (for contraception, fertility problems, menstrual problems, menopause symptoms, sexually transmitted infections (STI), experiences of intimate-partner violence (IPV), and cervical and breast cancer screening) and associated costs. We calculated average and total costs (including out-of-pocket spending, lost income, and estimated value of time spent) for women who incurred costs. We also estimated the total and average costs of meeting all SRH needs in a hypothetical “full needs met” year. Finally, we contextualize SRH spending against a measure of catastrophic expenditure (> 10% of household income).ResultsAmong the 385 women who participated, 94.8% had at least one SRH need in the prior 12 months; 79.7% incurred costs for accessing care. On average, women spent $28.34 on SRH needs during the prior year. Excluding one HIV-negative woman who spent 112% of her annual income on infertility treatment, HIV-positive women spent more on average annually for SRH care than HIV-negative women. Sixty percent of women reported at least one unmet SRH need. If all participants sought care for all reported needs, their average annual cost would rise to $52.65 per woman. Only two women reported catastrophic expenditure – for managing infertility.ConclusionsSRH needs are constants throughout women’s lives. Small annual costs can become large costs when considered cumulatively over time. As South Africa and other countries grapple with increasing access to SRH services under the rubric of universal access, it is important to remember that individuals incur costs despite free care at the point of service. Policies that address geographic proximity and service quality would be important for reducing costs and ensuring full access to SRH services.Plain English summaryLiterature on women’s financial and economic costs for accessing comprehensive sexual and reproductive health care in low- and middle-income countries is extremely limited, and existing literature often overlooks out-of-pocket costs associated with travel, child care, and time spent accessing services. Using data from a survey of 385 women from a public HIV treatment site and two public primary health care facilities in Johannesburg, we found nearly all women reported at least on sexual and reproductive health need and more than 75% of women incurred costs related to those needs. Furthermore, more than half of women surveyed reported not accessing services for their sexual and reproductive health needs, suggesting a total annual cost of more than $50 USD, on average, to access services for all reported needs. While few women spent more than 10% of their total household income on sexual and reproductive health services in the prior year, needs are constant and costs incur throughout a woman’s life suggesting accessing services to meet these needs might still result in financial burden. As South Africa grapples with increasing access to sexual and reproductive health services under the rubric of universal access, it is important to remember that individuals incur costs despite free care at the point of service. Policies that address geographic proximity and service quality would be important for reducing costs and ensuring full access to services.

Adolescent Sexual Reproductive Health Services in Bindura Urban of Zimbabwe

This study seeks to understand the capacity of adolescent-friendly reproductive health services (AFRHS) in promoting sexual reproductive health (SRP) among adolescents in Bindura Urban of Zimbabwe. The data collection methods used allowed the researcher to get insight on adolescents' experience and the factors associated with their accessing SRH services from AFRHS, the meaning of AFRHS for adolescents, healthcare providers' attitudes towards adolescents seeking SRH services, and community perceptions and readiness to accept AFRHS. The findings showed that both socio-cultural and health facility factors influence utilisation of SRH services. Many of these factors stem from the moral framework encapsulated in socio-cultural norms and values related to the sexual health of adolescents and healthcare providers' poor value clarification. This study provides an empirical understanding of the reasons and factors associated with SRH service utilisation, which goes much deeper than program provision of AFRHS in Zimbabwe.

Intimate partner violence, pregnancy intention and contraceptive use in Honduras

Objective(s)We explored the relationship between Intimate Partner Violence (IPV), pregnancy intention and contraceptive use in Honduras. Study designWe used the most recent Honduras Demographic and Health Survey (DHS 2011–2012) data to examine the relationship between physical IPV, sexual IPV and emotional IPV with pregnancy intention; contraceptive use; and husband's knowledge of contraceptive use among a sample of 6629 women. Multiple logistic regression was used to estimate effects of IPV on the outcomes, controlling for empowerment indicators and socio-demographic variables. ResultsAmong currently married women with at least one living child born within the past 5 years, IPV was significantly associated with several outcomes. Women reporting any physical IPV (13.5%) were less likely to have wanted their last child (aOR: 0.52, p<.001) or to desire future children (aOR: 0.76, p=.002), and more likely to have ever used contraception (aOR: 2.32 p=.004). Those reporting physical with sexual violence (4.1%) were less likely to have wanted their last child (aOR: 0.59, p=.016). Women reporting emotional IPV (27.4%) were less likely to have wanted their last child (aOR: 0.56, p<.001) or to desire more children (aOR: 0.81, p<.001) and more likely to have ever used (aOR: 1.78, p<.001) and currently be using contraception (aOR: 1.19, p=.006). Conclusion(s)IPV was associated with both unwanted pregnancy and increased contraceptive use among married Honduran women. Universal screening for IPV among women who seek SRH services in Honduras may help identify women in need and reduce stigma around IPV while improving SRH outcomes. ImplicationsHonduran women exposed to intimate partner violence (IPV) were more likely to have ever used contraception yet more likely to report an unwanted pregnancy. Universal screening for IPV among women seeking sexual and reproductive health services may help identify women in need and reduce stigma around IPV while improving outcomes.

School-Based Sexual and Reproductive Health Services for Prevention of Adolescent Pregnancy in the Hoima District, Uganda: Cluster Randomized Controlled Trial.

Uganda has persistently had high adolescent pregnancy prevalence; 25% for the last 10 years. This protocol presents the design of a Cluster Randomized Controlled Trial (CRCT) to investigate the effectiveness of School-Based Sexual and Reproductive Health (SBSRH) interventions on prevention of pregnancy among school girls aged 15–19 years in the Hoima District, Uganda. 18 secondary schools (clusters) will be selected using cluster sampling and allocated 1:1 into control or intervention group stratified by geographical location. 1080 (60 each cluster) participants/girls aged 15–19 years will be selected using simple random sampling. The intervention group will receive tailored SRH information, in-school medical care and referral over 12 months. The control group will receive no intervention from the research team; however, they can access alternative services elsewhere if they wish. Data will be obtained at baseline, 6 months and 12 months. The outcomes are reduction in occurrence of pregnancy, utilization of SRH services and sexual behavioral change. To our knowledge, this is the first CRCT providing combined SRH interventions for prevention of adolescent pregnancy in Uganda. If effective, it could have great potential in preventing adolescent pregnancy. Trial Registration: Pan African Clinical Trial Registry (PACTR201810882140200) Registered on 16 October 2018.

Barriers Limiting Youth Access to Reproductive Health Services by Primary Health Care Facilities in Nigeria

Youth represent a tremendously valuable asset to the society therefore working with them to make a healthy transition to adulthood is critical to the world's development now and in the future. The issue of youth-friendly health service has become a matter of concern as many young people still do not have access to such in the country. The community survey was designed to generate increased understanding of the barriers that limit youth access to sexual and reproductive health services(SRH) offered by Primary Health Care (PHC) facilities in Nigeria. Stratified and Purposive Sampling with qualitative and quantitative research methodology was adopted. Qualitative data were obtained through 12 Focus Group Discussions (FGDs) and 48 Key Informant Interviews (KIIs). For the quantitative component, an interviewer-administered questionnaire was used to elicit information from 300 randomly selected adolescents and youth. The mean age of respondents was 18.9 ± 4.4 years. Reported barriers to youth's access to SRH services were lack of awareness (67.3%), cost of services (46.7%), negative attitude of health care providers (39.7%) and fear of parents and what people will say (32.0%). The results shows that community mobilization for awareness creation and support on SRH issues (59.3%), will support youth to better access SRH services in PHC facilities

To be young, unmarried, rural, and female: intersections of sexual and reproductive health and rights in the Maldives

This paper explores sexual and reproductive health and rights (SRHR) among young people, identifying intersecting factors that create inequities in access to services, health-seeking behaviour, and ultimately health outcomes. Based on qualitative interviews with young people in the Maldives, it demonstrates how these intersectional experiences are contrary to what is often assumed in official data, policies, and services. Three factors were found to shape young people’s experiences: marital status, gender, and urban/rural differences. Non-marital sexual activity is illegal in the Maldives, but it is somewhat expected of unmarried men, while unmarried women are stigmatised for being sexually active. Although access to SRH services is restricted for all unmarried people, young women face additional difficulties, as the risk of being exposed is much greater in small island communities. Maldivian island communities are extremely small and characterised by an inward-looking culture that exerts considerable social pressure, particularly on unmarried women. For an unmarried woman, being known to be sexually active, or worse, pregnant outside of marriage, has severe social consequences including stigma and isolation from the community, and their own family. This concern is more prevalent among rural young women, as they live in smaller communities where stigma is inescapable. The need to avoid public scrutiny and humiliation contributes to making unsafe abortion a common solution for many unintended pregnancies. Failure to acknowledge these intersecting factors in SRHR experience and access has led to inequities among an already overlooked population, shaping their experiences, knowledge, health-seeking behaviour, and health outcomes.

A Web-based review of sexual and reproductive health services available at colleges and universities in Georgia

ABSTRACTObjective: Although two-thirds of graduating high school seniors attend college or university in the U.S., there is a paucity of national or state specific research regarding SRH services available on or near college and university campuses.Methods: A review of websites for all colleges and universities in Georgia was conducted to evaluate sexual health services available on campuses and evidence of referral to community providers.Results: Of 96 colleges in Georgia, 44 had campus-located health centers, with only 3 at two-year colleges. Overall SRH service provision was low, with great variation between colleges. Distances between colleges and Title X clinics ranged from 0.33 to 35.45 miles.Conclusions: Many students lack access to campus health centers, and information on college websites regarding SRH service availability and referrals differs dramatically between campuses. In the absence of robust campus-located services, schools should highlight where students can obtain comprehensive SRH care in the community.

Sexual and reproductive health services (SRHS) for adolescents in Enugu state, Nigeria: a mixed methods approach

BackgroundAvailability and accessibility of sexual and reproductive health services for adolescents are very crucial for prevention and control of sexual and reproductive health problems. These services also play vital roles in the promotion of adolescents’ sexual and reproductive health generally. The main purpose of the study was to determine the availability and accessibility (geographical and financial) of sexual and reproductive health services (SRHS) among adolescents in Enugu State, Nigeria.MethodsA mixed methods approach was adopted for the study. 192 health facilities were reached to check availability of SRH services. Randomly sampled 1447 adolescents (12–22 years) completed the questionnaire correctly. Twenty-seven interviews and 18 group discussions were conducted. Instruments for data collection consisted of a checklist, a questionnaire, a focus group discussion guide and an in-depth interview guide. All instruments were pre-tested. Quantitative data were analyzed using descriptive statistics and Chi-square tests. NVivo 11 Pro software was used to code and thematically analyze the qualitative data.ResultsA total of 1447 adolescents (between 12 and 22 years) completed the questionnaire correctly. Among these adolescents, males constituted 42.9% while females were 57.1%. The majority (86.7%) of the adolescents reported availability of safe motherhood services, and 67.5% reported availability of services for prevention and management of STIs and HIV and AIDS. The majority reported that these services were geographically accessible but few were financially accessible to adolescents. However, qualitative data revealed that available services were not specifically provided for adolescents but for general use. Age (p = ≤ .05), education (p = ≤ .05) and income (p = ≤ .05) were found to be significantly associated with access to SRHS.ConclusionSRHS were generally physically available but not financially accessible to adolescents. Adolescents’ clinics were not available and this could affect the access of SRHS by adolescents. Education and income were significantly associated with access to SRHS.

Facilitating access to adolescent sexual and reproductive health services through legislative reform: Lessons from the South African experience.

South Africa (SA) has progressive legislation enabling adolescents to access various sexual- and reproductive-health services (SRH) independently, without consent from parents or legal guardians. This article reviews the SA legislative framework for adolescent access to SRH interventions. It outlines the five approaches adopted in current legislation to address adolescents' capacity to independently consent to specified health interventions, based on age, capacity and public policy requirements, or combinations thereof. Rather than subsume various health interventions under the umbrella of medical treatment, SA has separately legislated on many SRH interventions (e.g. HIV testing, contraceptives and terminations of pregnancy, among others). We identify strengths and weaknesses of the SA approach, and conclude with lessons learned from the SA experience which could inform discussion and debate on the most appropriate ways for countries to consider law reform that facilitates adolescent access to SRH services.

P228 Sexual &amp; reproductive healthcare outcomes among those at risk of child sexual exploitation: a retrospective review

IntroductionThe purpose of Multi-Agency Sexual Exploitation (MASE) panels is to consider cases of high risk victims and offenders in relation to Child Sexual Exploitation (CSE) and the criminal justice response to offenders. A multiagency approach should ensure young people (YP) are supported by appropriate services including SRH.MethodsA retrospective review of a selection of MASE cohorts from 2016 from three services across England was undertaken. The names of YP were cross-referenced with the SRH clinic system in the locality to determine if they had accessed the service. Information was collected on reason for attendance, sexual health screening, contraception and gravidity. Data was analysed using Excel.ResultsOf 92 young people discussed at MASE panel, 64 (69.6%) were known to SRH services. The age range was 12–19 years (median 16). Sixty (93.7%) were female. The most common reasons for attendance were request for contraception (35.9%), pregnancy testing (25%) and disclosure of sexual assault (10.9%).19 (29.7%) individuals had tested positive for chlamydia on at least one occasion (25 episodes in total). Fourteen pregnancies were reported with 8 resulting in termination.DiscussionRates of chlamydial infection and pregnancy were high among the MASE cohorts reviewed. The multi-agency response should provide an opportunity to address health needs of this vulnerable group. Interventions should be targeted accordingly including prioritising referral into SRH services into the care plans of those identified to be at risk of CSE.

P170 Improving staff integration through means of a combined clinic rota

IntroductionWith the national move to integrated sexual health services confusion regarding staff leadership and roles can increase already high levels of stress and anxiety. Costs for professional rota management services can vary so we aimed to achieve an in-house system.MethodsThough co-located in the same building SRH and GU/HIV clinics were traditionally staffed separately. The local tender was awarded to the University Hospital clinic as hub with spokes providing an equitable city-wide service. Previously there were four separate rotas to staff SRH, GUM, and HIV services. Bringing together a group of health professionals with varying degrees of dual training can be difficult so we took this opportunity to ensure an adequate skill mix was available for each clinic, help staff identify who was available for advice, improve cross-specialty training and thereby enhance the overall patient experience. A clinic co-ordinator doctor role was established to provide focus for leadership and advice (GU/HIV) with corresponding clinic co-ordinator nurse staffed by senior contraception clinicians.DiscussionRotas were combined onto a single colour-coded template. Editing rights were restricted to named individuals aware of staff mix and availability. Numbers were calculated at the start of each day and communicated to reception to ensure spread of appointments. The CCD role was utilised to help teach SRH colleagues in GU with the CCN providing a reciprocal service for contraception. Combining the rota encouraged staff to integrate and get to know each other so that perceived fears were dealt with in a safe reassuring environment.

What is it going to take to move youth-related HIV programme policies into practice in Africa?

Introduction: HIV has been reported to be the leading cause of mortality amongst adolescents in Africa. This has brought attention to the changes in service provision and health management that many adolescents living with HIV experience when transferring from specialized paediatric- or adolescent-focused services to adult care. When transition is enacted poorly, adherence may be affected and the continuum of care disrupted. As the population of HIV-infected adolescents grows, effective and supported transition increases in significance as an operational imperative.Discussion: Considerable gaps remain in moving policy to practice at global, national, and local levels. Policies that give clear definition to transition and provide standard operating procedures or tools to support this process are lacking. National guidelines tend to neglect transition. Beyond transition itself, there has been slow progress on the inclusion of adolescents in national policies and strategies. Guidance often overlooks the specific needs and rights of adolescents, in particular for those living with HIV. In some cases, prohibitive laws can impede adolescent access by applying age of consent restriction to HIV testing, counselling and treatment, as well as SRH services. Where adolescent-focused policies do exist, they have been slow to emerge as tangible operating procedures at health facility level. A key barrier is the nature of existing transition guidance, which tends to recommend an individualized, client-centred approach, driven by clinicians. In low- and middle-income settings, flexible responses are resource intensive and time consuming, and therefore challenging to implement amidst staff shortages and administrative challenges. First, national governments must adopt transition-specific policies to ensure that adolescents seamlessly receive appropriate and supportive care. Second, transition policies must form part of a broader adolescent-centred policy landscape and adolescent-friendly orientation and approach at health system level. Third, national actors must ensure that transition policies are supported at implementation level. Fourth, youth involvement and community mobilization are essential. Finally, further implementation research is urgently needed to better understand how to support young people and providers in achieving smooth transitions.Conclusions: Only by moving from policy to practice through supportive policies and their implementation will we be closer to including adolescents in the 2030 goal of ending AIDS.