Youth-friendly Health Services Research Articles

Perceptions and preferences regarding sex and contraception, amongst adolescents.

Introduction:Conceptually and by the outlook, the reproductive and sexual health needs of adolescents differ from those of adults. Adolescent girls are coerced into unwanted sex or marriage, putting them at risk of unwanted pregnancies, unsafe abortions, sexually transmitted infections (STIs) including HIV, and dangerous childbirth. A majority of young people do not have correct information on the use of contraceptives or the prevention of pregnancy and STIs, and youth-friendly reproductive health services are not readily available.Materials and Methods:A community-based cross-sectional study conducted among school-going 500 adolescent girls in the field practice area of Urban Health Training Centre, Tripuri, of Government Medical College, Patiala (Punjab). A survey with semi-structured, self-administered, and pretested questionnaire was conducted to collect the information on demographic characteristics, and knowledge and perceptions about safe sex.Results:Only 39.71% of girls were aware that the legal age of marriage of girls in India is 18 years. About 22% of girls said that they would prefer to have pre-marital sex and majority, out of them, belonged to nuclear families. Around 38.4% of girls knew that condom is the safest contraceptive method but a preferred choice of contraceptive method among the girls for condoms (24.40%), oral pills (20.20%), and emergency pill (19.60%).Conclusion:Choice of the method with lower levels of knowledge regarding STIs and 22% preferring premarital sex may expose them to higher risks. Increasing trends of pre-marital sex with lower levels of awareness about contraception and STIs is very detrimental.

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

Comparing Youth-Friendly Health Services to the Standard of Care Through "Girl Power-Malawi": A Quasi-Experimental Cohort Study.

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

Appointed by young people – a qualitative study on young patients recruiting hospital staff in Denmark

There is a lack of knowledge about young peoples'wishes for the qualifications including skills and personal traits of hospital staff during the recruitment process. The aim of this qualitative study was to explore which qualifications, skills and personal traits young people prefer when recruiting hospital staff. A Youth Recruitment Committee (YRC) consisting of four young people performed six job interviews in parallel to conventional job interviews at Copenhagen University Hospital Rigshospitalet, Denmark. The interviews with the candidates and the subsequent YRC deliberation were observed and recorded, and data were analyzed using thematic analysis. Four main themes with matching sub-themes emerged from the data: (1) Personality (appearance and commitment), (2) Professional skills (approach, mentality and activities), (3) Project management (skills and experience), (4) Communication (during the interview and experiential approach to youth). It was important to the YRC that the candidate had professional experience working with young people as well as being a skilled project manager. The YRC also assessed the candidates´ communication during the interview. By inviting young people in as a separate recruitment committee, their perspectives and preferences were noted without interference from professionals. Our findings are in line with previous research regarding young peoples´ preferences on youth-friendly health services. Furthermore, this approach made it possible to evaluate candidates´ communication skills with young people as they were assessed during the job interviews.

Training in youth-friendly service provision improves nurses' competency level in the Great Lakes Region.

This survey investigates whether relevant training and availability of guidelines improve self-reported competencies of nurses in the provision of youth-friendly sexual and reproductive health services in South-Kivu Province in the Democratic Republic of the Congo, Burundi, and Rwanda. A quantitative baseline survey was conducted among nurses in randomly selected health facilities. Nurses providing youth-friendly sexual and reproductive health services were asked to self-rate their competencies with regards to technical knowledge, clinical, and communication skills. In South-Kivu, Burundi, and Rwanda, 135, 131, and 99 nurses were interviewed, respectively. Overall differences of service and guideline availability and self-rated competencies can be observed between the three countries. In two countries, more than one in five nurses considered themselves to be only somewhat or not confident to counsel young people. Nurses from Rwanda showed the highest level of competencies followed by Burundi and South-Kivu. Lack of training in youth-friendly health services or family planning showed significant associations with reporting feeling somehow or not competent. The lack of training, supervision, and guidelines expressed by the nurses is of great concern. Competency-based training in youth-friendly health services is an important approach in improving nurses' competency level.

Based on the perceptions of community stakeholders, how can adolescent pregnancies be prevented? A qualitative study

Background: Adolescent pregnancy an important problem in adolescent health and government agencies need to focus on solving problem. The purpose of this research was to survey the perceptions of community stakeholders concerning the prevention of adolescent pregnancies in rural communities.Methods:Data collection was performed using group meetings with 103 stakeholders involved in adolescent pregnancy prevention. They were nurses, public health officials, parents or guardians, students, teachers, public health volunteers and community leaders. Thematic analysis indicated work on adolescent pregnancy prevention problems in rural areas was carried out by only some agencies such as district and sub-district health promoting hospitals, providing youth-friendly health service clinics and educating student leaders in schools on sex education.Results: Collectively, these results draw attention to the need for an appropriate program to strengthen adolescent, family and practitioner skills for the prevention of teenage pregnancies. Schools provide sex education as part of a health education curriculum, and some schools provide additional instruction in guidance classes. Problems from inconsistent work when networks fail were encountered. Stakeholders believe adolescent pregnancy prevention should focus on the following: (1) adolescents should receive training for skill development with content related to knowledge about sex, negotiation, refusal, morality and ethics, (2) teachers should receive training on comprehensive sexual education, and, (3) families should work to improve their communication on sexual health and developmentConclusions: There is a strong need for families to develop the ability to communicate with each other about sexuality and reproductive health. Developing parenting skills on how and when to talk about sex with their adolescents and open parental communication on sexuality issues at home is necessary. Activities need to also be developed for adolescents who are more inclined to engage in risky sexual behaviors.

Assessing youth-friendly sexual and reproductive health services: a systematic review

BackgroundOver the last quarter century, there has been an emergence of evidence-based research directed toward the development, implementation, and assessment of youth-friendly health services (YFHS) to improve the delivery of sexual and reproductive health services for young people. Despite these research efforts, evidence supporting the effectiveness of YFHS is limited, which may be attributed to a lack of consensus on how to define and measure youth-friendliness to track progress and evaluate outcomes. The purpose of this systematic review is to assess how youth-friendly sexual and reproductive health services are measured worldwide.MethodsWe conducted a systematic review of studies measuring youth-friendly sexual and reproductive health services at health facilities published between January 2000 and June 2015 using PubMed, Web of Science, and POPLINE databases. Additional studies were identified by reviewing references of selected articles. Studies were screened to identify measurements and indicators that have been used to measure YFHS.ResultsOur review identified 20 studies from an initial search of more than 11,000 records, including six from high-income countries and 14 from low-and middle-income countries. The review identified 115 indicators used for measuring youth-friendly sexual and reproductive health services. Our review found a lack of consistency in the tools and indicators used to measure YFHS. The three most frequently assessed domains were accessibility, staff characteristics and competency, and confidentiality and privacy. The majority of the indicators were not specific to young people’s needs and often reflected basic standards of care.ConclusionsThis review shows the need for standardization and prioritization of indicators for the evaluation of YFHS. The results can be used to identify a core set of indicators that can be incorporated into a framework for assessing youth-friendly sexual and reproductive health services. There is a need to further distinguish between those variables that may have greatest impact on the use of services by young people, such as respect and privacy, those that impact the quality of services offered, and those that have limited relevance. Conducting more rigorous studies using a refined set of indicators is critical to measure and compare the impact and effectiveness of YFHS efforts.

Mainstreaming youth-friendly health services into existing primary health care facilities: experiences from South-South Nigeria.

Background Youth friendly services, an evidence based approach to overcome the barriers experienced by youths in accessing care, is poorly implemented. The Medical Women's Association of Nigeria (MWAN) Rivers State chapter, was supported by Ford Foundation to mainstream youth-friendly health services (YFHS) into existing primary health care facilities in two hard-to-reach communities. This paper presents the interventions, findings, challenges and recommendations. Methods This study project was implemented in stages: design, baseline survey, interventions and evaluation, between 2014 and 2016. Interventions included facility modifications, health worker capacity building, school and community outreaches, peer group activities, and interpersonal communication. Pre-and-post-intervention surveys were carried out among in- and out-of-school youths to determine the effects of the interventions. Results The most commonly stated barriers to uptake of youth friendly health services included: unavailability of services (154; 33.1%), unavailability of health care workers (167; 38.9%), unaffordability of services (108; 45.8%) and difficulty in communicating with health workers (85; 36.0%). Post-intervention, utilization improved across all services while the perception of barriers to utilization of services reduced (p < 0.05). The interventions implemented increased the odds of youths utilizing YFHS 1.81 times (95% CI = 1.39-2.37). Conclusion Facility modifications, capacity building of health workers, school and community outreaches, peer group activities, and interpersonal communication improved utilization across all services while the perception of barriers to utilization of services reduced. Implementation of YFHS is impacted by external factors often beyond the control of project implementers. Innovative solutions outside of routine health care delivery systems are critical for success. Further evaluation to explore the effect of these interventions is needed. Strengthening of health systems remains a vital strategy for scale-up of YFHS.

Fenomena Pernikahan Dini Membuat Orang Tua dan Remaja Tidak Takut Mengalami Kehamilan Tidak Diinginkan

AbstrakKasus KTD pada remaja Kabupaten Pati yang berusia &lt; 17 tahun sebanyak 43,8%, yang berdampak pada pernikahan di usia dini semakin meningkat. Penelitian ini bertujuan untuk mendeskripsikan respon orang tua dan remaja SMP yang mengalami KTD, serta dampak pernikahan di usia dini. Metode penelitian ini adalah kualitatif dengan desain studi kasus. Pengambilan sampel dengan cara purposive dan pengumpulan data menggunakan indepth interview. Informan utama adalah remaja yang mengalami KTD 5 orang. Informan triangulasi orang tua informan 5 orang. Hasil penelitian menunjukan fenomena pernikahan dini membuat orang tua dan remaja tidak takut mengalami kehamilan tidak diinginkan, akibatnya masyarakat yang dahulu menganggap hubungan seks pranikah perilaku yang melanggar norma, sekarang cenderung lebih bisa diterima oleh masyarakat. Orang tua dan remaja yang tinggal didaerah rural memberikan respon untuk menyelesaikan permasalah KTD dengan menikahkan informan. Sedangkan yang tinggal didaerah urban, meminta informan untuk melakukan aborsi, tetapi setelah gagal akhirnya informan dinikahkan. Pernikahan menjadi solusi KTD yang dialami remaja karena masyarakat permisif terhadap pernikahan diusia dini dan budaya dimasyarakat yang menganggap jika kewajiban perempuan hanya disektor domestik, sehingga kodrat perempuan adalah menjadi ibu urmah tangga. Disarankan memberikan informasi kepada remaja dan orang tua tentang dampak pernikahan dini. Pemerintah khususnya DKK Pati bisa lebih memberikan pelayanan kesehatan yang ramah remaja sejak tingkat SMP.Kata kunci : KTD, pernikahan dini, remaja SMPAbstractIn Pati District KTD cases in adolescents aged &lt;17 years as much as 43.8%, which affects the marriage at an early age is increasing. This research aims to describe the response of parents and teens junior who experience unwanted pregnancy, and the effects of marriage at an early age. This research method was qualitative case study design. With a purposive sampling and data collection using in-depth interviews. The main informants were adolescent who experienced unwanted pregnancy 5 people. Informants triangulation parents 5 people. The results showed the phenomenon of early marriage makes parents and teens are not afraid of an unwanted pregnancy, as a result people who previously regarded premarital sex behavior that violates norms, are now more likely to be accepted by society. Parents and teenagers who live rural areas provide a response to resolve the problem by marrying unwanted pregnancy informant. While living urban areas, asking informants to have an abortion, but after failing informant eventually wed. Marriage was a solution unwanted pregnancy experienced by adolescents because of the permissive society towards marriage early age and culture in the community who think if the domestic sector only female duties, so that the nature of women is to be a housewife. Suggested provide information to adolescents and parents about the effects of early marriage. The government particularly Health Provider can further provide youth- friendly health services since the junior level.Keywords: unwanted pregnancy, early marriage, adolescents of junior high school

Comparing youth-friendly health services to the standard of care through "girl Power-Malawi": A quasi-experimental cohort study

Comparing youth-friendly health services to the standard of care through "girl Power-Malawi": A quasi-experimental cohort study

Comparing four service delivery models for adolescent girls and young women through the ‘Girl Power’ study: protocol for a multisite quasi-experimental cohort study

IntroductionIn sub-Saharan Africa, adolescent girls and young women (AGYW) face a range of sexual and reproductive health (SRH) challenges. Clinical, behavioural and structural interventions have each reduced these risks and...

New Findings on Child Marriage in Sub-Saharan Africa

Despite increasing global attention and commitments by countries to end the harmful practice of child marriage, each year some 15 million girls marry before the age of 18. The preponderance of the evidence produced historically on child marriage comes from South Asia, where the vast majority of child brides live. Far less attention has been paid to child marriage in sub-Saharan Africa, where prevalence rates remain high. The International Center for Research on Women (ICRW) recently conducted research in Kenya, Senegal, Uganda, and Zambia to contribute to greater understanding of the drivers of child marriage in each of these contexts. Synthesizing findings from 4 diverse countries provides a useful opportunity to identify similarities and differences, as well as understandings that may be applicable to and helpful for preventing child marriage across these and other settings.Across the 4 countries, ICRW's research echoes the existing literature base in affirming that child marriage is rooted in inequitable gender norms that prioritize women's roles as wives, mothers, and household caretakers, resulting in inadequate investments by families in girls' education. These discriminatory norms interact closely with poverty and a lack of employment opportunities for girls and young women to perpetuate marriage as a seemingly viable alternative for girls. We found in the African study sites that sexual relations, unplanned pregnancy, and school dropout often precede child marriage, which differs from much of the existing evidence on child marriage from South Asia. Further, unlike in South Asia, where family members typically determine the spouse a girl will marry, most girls in the Africa study settings have greater autonomy in partner choice selection. In Senegal, increasing educational attainment and labor migration, particularly by young women, has contributed to reduced rates of child marriage for girls.Our findings suggest that improving gender equitable norms and providing more—and more equitable—opportunities for girls, particularly with regard to education and employment, are likely to improve child marriage outcomes. Providing comprehensive sexuality education and youth-friendly reproductive health services can reduce rates of early pregnancy that contribute to child marriage. Finally, identifying ways in which to improve communication between parents and adolescent daughters could go far in ensuring that girls feel valued and that parents feel heard as they make decisions together regarding the lives and opportunities of these adolescent girls.

Strengthening Youth Friendly Health Services through Expanding Method Choice to include Long-Acting Reversible Contraceptives for Ethiopian Youth.

Despite robust evidence regarding long-acting reversible contraceptive (LARC) low failure rates, immediate return to fertility and safety, LARC uptake among youth is low. We evaluated the effect on contraceptive uptake of training youth-friendly service providers to counsel and provide all contraceptive methods including LARCs in the same unit. A convenience purposive sampling technique was used to select 20 youth friendly health units; ten each in Amhara and Tigray regions, Ethiopia; randomly allocated to the intervention (five) and non-intervention (five) arms. Data were abstracted from the family planning registers over an eleven-month period: three months pre-intervention and eight months post-intervention. Analysis of contraceptive uptake and chi-square tests of association were conducted. The number of LARCs new acceptors in the intervention arm was 781 (pre-intervention=116; post intervention=665) as compared to 358 in the non-intervention arm (pre-intervention=95; post intervention=263). Odds of adopting LARCs at pre-intervention (0.70); rose to 1.30 for the post-intervention phase (p-value <0.0001); comparing intervention to non-intervention study arms. Training youth friendly service providers to counsel and provide all contraceptive methods including LARCs in one location resulted in higher LARCs uptake for all sexually active young women; including those planning on delaying their first pregnancy.

Consumer views on youth-friendly mental health services in South Australia

ABSTRACTObjective: This study sought to understand the perspectives of young people (12–25 years) with experience of mental health services on what makes for youth-friendly mental health services.Method: A purposive strategy was used to recruit 32 young people aged 12–25 years with diverse backgrounds, through mental health and youth services. Six semi-structured group interviews were undertaken and one individual interview. We were especially interested in aspects that facilitated or obstructed young people from seeking help, and key experiences across their consumer journey. Transcripts were analysed thematically to identify shared experiences and perspectives across the interviews.Results: Five key themes emerged: the central role that teachers, school counsellors, parents, and friends play in help seeking and responding to crisis; the impact of fear, uncertainty, and stigma in decision-making and engaging with services; finding the right therapist and effective help; ways to improve flexibility and ease of access; the need for better quality consumer information for accessing a mental health service.Discussion: The results of the study have implications for the design of mental health services, providing important insights that can increase young people’s engagement with services, and ultimately, improve the mental health and well-being of young people in Australia.

Validation of a questionnaire to measure youth-friendliness of Swedish youth clinics.

This study presents the validation process of a tool to assess the youth-friendliness of Swedish youth clinics, based on the Youth-Friendly Health Services - World Health Organization Plus (YFHS-WHO+) questionnaire but adapted to the specific context of differentiated services catering only for young people in this country. The validation process followed five steps: (1) translation, (2) revision by professionals, (3) pretests with young people, (4) back-translation and discussion with the developers of the original YFHS-WHO+ questionnaire and (5) internal consistency and test-retest reliability testing. The final Swedish version, titled Youth-Friendly Health Services-Sweden (YFHS-Swe), differs from the original in terms of adjustments in language and in changes to make it better correspond to the reality of the Swedish youth clinics, while maintaining the meaning and intention of the original questionnaire. The YFHS-Swe questionnaire generated reproducible responses (test-retest coefficient of 0.79 for the total score) and can be considered a measure of a cohesive construct (Cronbach alpha of 0.95 for the total score). The study suggests that the YFHS-Swe questionnaire is a reliable instrument that can be an asset for youth clinics to evaluate their work and make regional and national comparisons between clinics. The YFHS-Swe could also serve as a basis for validating instruments to assess youth-friendliness of differentiated services for young people in other countries.

High Magnitude of Social Anxiety Disorder in School Adolescents.

Introduction. Social phobia is the most prevalent and chronic type of anxiety disorder worldwide and it affects occupational, educational, and social affairs of the individual. Social phobia is also known for its association with depression and substance use disorder. Objective. The aim of this study was to assess the prevalence and associated factors of social phobia among high school students in Ethiopia. Methods. Cross-sectional study was conducted among 386 randomly selected students. Data were collected using pretested and self-administered questionnaire. Social phobia was assessed by using Social Phobia Inventory (SPIN). Logistic regression was used to analyze the data with 95% confidence interval and variables with p value less than 0.05 were considered as statistically significant. Results. From 386 study participants, 106 (27.5%) of them were positive for social phobia. Being female (AOR = 3.1; 95% CI: 1.82–5.27), current alcohol drinking (AOR = 1.75; 95% CI: 1.03–2.98), poor social support (AOR = 2.40; 95% CI: 1.17–4.92), and living with single parent (AOR = 5.72; 95% CI: 2.98–10.99) were significantly associated with social phobia. Conclusion. The proportion of social phobia was higher compared to previous evidences. School-based youth-friendly mental health services might be helpful to tackle this problem.

Using Technology to Identify Risk and Meet Demands: An Innovative Clinical Pathway

Background: Over the past decade, there has been a significant push by the Australian government to fund youth-friendly mental health services that are non-stigmatizing, low cost, and accessible. One such organization is headspace: the National Youth Mental Health Foundation. This initiative has been highly successful; unfortunately, workforce and funding resources have not been able to keep up with the ever-growing demand, resulting in increasingly lengthy wait times for young people. Objective: The aim was to investigate how technology could be integrated into current pathways of care to reduce wait times for young people accessing headspace centers and to help identify those young people at greatest risk. Objectives were to understand current clinical pathways, determine the technological requirements needed to ensure seamless integration, identify indicators of risk that highlight those young people in greatest need for immediate care, and develop a new clinical pathway that seamlessly incorporates the new technology. Methods: An electronic holistic psychosocial assessment tool (EhHAT) was developed in collaboration with young people and service providers, with service providers specifying “critical” items they considered most indicative of risk. Center managers were also interviewed to determine current and potential pathways of care and technological requirements. The EhHAT was then administered to 151 young people attending a headspace center to determine the “critical items” most likely to identify the top 10%-20% of young people at greatest risk of harm. Results: The critical items considered most indicative of risk included but were not limited to a suicide screen score ≥10, current homelessness, self-harming behaviors in the previous month, psychotic experiences in the previous month, daily use of drugs, and an extreme K10 score. After administering the ehHAT to young people, it was found that the suicide screen would positively identify the top 11.9% of young people most at risk. In addition to those already identified via the suicide screen, a further 13.24% would be identified as “at risk” by endorsing 3 or more “critical” items or a further 5.29% identified by endorsing 4 or more items. Interestingly, while 23.07% of participants who endorsed 3 or more critical items also had a suicide screen of ≥10, 72.72% of those who endorsed 4 or more items also had a suicide screen of ≥10. In order to ensure seamless integration into clinical pathways, technological requirements included the ability to complete the assessment via mobile, tablet or computer, automated risk alerts to clinicians via text, clear highlighting of risks to clinicians via a summary, and the ability to integrate this assessment into current client data management tools. Conclusions: With appropriate considerations and adaptations, technology can be integrated into clinical pathways to assess young people before they see a clinician. Such assessment ensures young people at the greatest risk of harm receive care quickly. Furthermore, the early identification of those with milder symptoms allows young people to be re-directed to alternative treatment options. Utilizing this stepped care approach will reduce wait times for those with more severe symptomology and those at greatest risk of harm. [iproc 2016;2(1):e39]

Challenges and strategies for sustaining youth-friendly health services - a qualitative study from the perspective of professionals at youth clinics in northern Sweden.

BackgroundYouth-friendly health-care services — those that are accessible, acceptable, equitable, appropriate and effective for different youth subpopulations – are beneficial for youth health, but not easy to implement and sustain. Sweden is among the few countries where youth-friendly health-care services have been integrated within the public health system and sustained for a long time.This study explores the challenges and strategies in providing sustainable youth-friendly health-care services, from the perspective of professionals working in youth clinics in northern Sweden.MethodsEleven semi-structured interviews with various health-care professionals working in youth clinics in northern Sweden were conducted. The interviews were transcribed verbatim, and analysed using thematic analysis in relation to the World Health Organization domains of youth friendliness.ResultsFour themes emerged from the analysis of the data: 1) ‘Meeting youths on their own terms – the key to ensuring a holistic and youth-centred care’ was related to the acceptability and appropriateness of the services; 2) ‘Organizational challenges and strategies in keeping professionals’ expertise on youth updated’ referred to the domain of effectiveness; 3) ‘Youth clinics are accessible for those who know and can reach them’ was related to the domains of accessibility and equity, and 4) ‘The challenge of combining strong directions and flexibility in diverse local realities’ focused on the struggle to sustain the youth clinics organization and their goals within the broader health system.ConclusionsProfessionals working in youth clinics are perceived as motivated, interested and knowledgeable about youth, and the clinics ensure confidentiality and a youth-centred and holistic approach. Challenges remain, especially in terms of ensuring equitable access to different youth subpopulations, improving monitoring routines and ensuring training and competence for all professionals, independently of the location and characteristics of the clinic. Youth clinics are perceived as an indisputable part of the Swedish health system, but organizational challenges are also pointed out in terms of weak clear directives and leadership, heavy workload, local/regional diversity and unequitable distribution of resources.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0261-6) contains supplementary material, which is available to authorized users.

Determining Preferences Related to HIV Counselling and Testing Services Among High School Learners in KwaZulu-Natal: A Discrete Choice Experiment.

A key strategy of the South African national response to HIV is the scale-up of HIV counselling and testing (HCT) in the 15-49years age group. The integrated school health policy aims to guide the roll out of youth-friendly health services including the provision of HCT in schools. Using a discrete choice experiment to examine preferences regarding the attributes of HCT service packages, this study identifies barriers to and facilitators of HCT among high school learners. Monetary considerations were found to have the strongest effect of any attribute on choice, whilst confidentiality was found to be a primary concern for learners considering HCT. Policy makers and service providers must ensure that confidentiality is maintained, and could consider using monetary incentives as a way of increasing uptake of HCT. Programmes designed to reduce social stigma and improve education and knowledge dissemination around HCT and HIV, are vital in creating demand for HCT and changing attitudes among young people.

Preventing HIV among adolescents with oral PrEP: observations and challenges in the United States and South Africa.

IntroductionAdolescents and young adults aged <25 are a key population in the HIV epidemic, with very high HIV incidence rates in many geographic settings and a large number who have limited access to prevention services. Thus, any biomedical HIV prevention approach should prepare licensure and implementation strategies for young populations. Oral pre-exposure prophylaxis (PrEP) is the first antiretroviral-based prevention intervention with proven efficacy across many settings and populations, and regulatory and policy approvals at global and national levels are occurring rapidly. We discuss available data from studies in the United States and South Africa on the use of oral PrEP for HIV prevention in adolescent minors, along with some of the implementation challenges.DiscussionOngoing studies in the United States and South Africa among youth under the age of 18 should provide the safety data needed by the end of 2016 to contribute to licensure of Truvada as daily PrEP in adolescents. The challenges of completing these studies as well as foreseeable broader challenges highlighted by this work are presented. Adherence to daily PrEP is a greater challenge for younger populations, and poor adherence was associated with decreased efficacy in all PrEP trials. Individual-level barriers include limited familiarity with antiretroviral-based prevention, stigma, product storage, and social support. Structural challenges include healthcare financing for PrEP, clinician acceptability and comfort with PrEP delivery, and the limited youth-friendly health services available. These challenges are discussed in the context of the work done to date in the United States and South Africa, but will likely be magnified in the setting of limited resources in many other countries that are heavily impacted by HIV.ConclusionsAdolescent populations are particularly vulnerable to HIV, and oral PrEP in these populations is likely to have an impact on population-level HIV incidence. The challenges of disseminating an HIV biomedical prevention tool requiring daily usage in adolescents are formidable, but addressing these issues and starting dialogues will lay the groundwork for the many other HIV prevention tools now being developed and tested.