Evaluating use of mass-media communication intervention 'MTV-Shuga' on increased awareness and demand for HIV and sexual health services by adolescent girls and young women in South Africa: an observational study

Co-designing Healthcare Interventions with Users: A Discrete Choice Experiment to Understand Young People's Preferences for Sexual and Reproductive Health Services in Lusaka, Zambia

INTRODUCTION

Like in many countries, coverage of sexual and reproductive health (SRH) services among adolescents and young people (AYP) aged 15-24 remains low in Zambia. Increasing coverage of SRH services requires interventions that are responsive to the needs and preferences of AYP. We conducted a discrete choice experiment (DCE) to elicit AYP's preferences for SRH service delivery in Lusaka, Zambia.

METHODS

A cross-sectional DCE was conducted with AYP aged 15-24 years. Consenting participants were presented with alternative SRH service delivery strategies represented by six attributes, namely: location, type of provider, type of services, service differentiation by sex, availability of edutainment, and opening hours. Multinomial logit and random parameters logit models were used to analyse the data. All variables were effect coded.

RESULTS

A total of 423 AYP aged 15-24 years (61% female) completed the DCE. Respondents preferred SRH services that were integrated with other healthcare services (b = 0.65, p < 0.001), delivered by medical staff and peer support workers (b = 0.44, p < 0.001), and provided at a hub within a health facility (b = 0.62, p < 0.001). AYP also preferred services to be available on weekends during the daytime (b = 0.37, p < 0.001). Participants also preferred alternatives which included edutainment (b = 0.22, p < 0.001). Service differentiation by sex had little effect on the preference for SRH service delivery (b = - 0.05, p = 0.08). The coefficient for the "neither" option was negative and statistically significant (b = - 5.31, p < 0.001), implying that AYP did not favor routine SRH service delivery in an outpatient department.

CONCLUSION

Efforts to increase SRH service utilization among AYP should focus on providing comprehensive SRH services that are integrated with other healthcare services. These services should be delivered by a combination of medical staff and peer supporter workers in youth-friendly spaces. Careful attention should be paid to opening times to ensure that these are convenient to AYP.

Scoping review of social norms interventions to reduce violence and improve SRHR outcomes among adolescents and young people in sub-Saharan Africa

Introduction

Despite growing interest, guidance to inform effective social norms interventions that improve adolescents and young people's sexual and reproductive health and rights (SRHR) is needed.

Methods

We conducted a scoping review of experimental and quasi-experimental studies of social norms interventions in sub-Saharan Africa. Single and multi-component interventions that included a social norms component and assessed impacts on SRHR outcomes among 10- to 24-year-old adolescents and young people were included. We mapped interventions across eight programmatic strategies and six SRHR outcomes, drawing programmatic insights.

Results

N = 40 interventions from 12 countries reported effectiveness on intimate partner and non-partner sexual, physical and emotional violence (N = 14), child marriage (N = 6), sexual risk behaviours (N = 20), contraception and family planning (N = 23), prevention and treatment of HIV and other sexually transmitted infections (N = 17), and early pregnancy (N = 10). Intervention strategies included life skills approaches (N = 23), community dialogues (N = 14), school-based SRHR programming (N = 10), parenting programmes (N = 8), training of healthcare professionals on youth-friendly services (N = 7), media or digital-based approaches (N = 7), interventions with community leaders (N = 5), and rights-based advocacy (N = 2). Norms interventions can improve multiple SRHR outcomes, including reducing gender-based and intimate partner violence and child marriage, increasing HIV testing, and contraceptive use. Effective programmes were often implemented in combined interventions, and included life skills, community conversations, mass media and digital programmes with norms components.

Discussion

Integrating gender-transformative approaches such as reflections on gender roles and inequalities, youth sexuality, and gendered power relations, and engaging with reference groups were key to the success of programmes. Effective approaches delivered SRHR information alongside reflections on social norms, and combined participatory methods with a structured curriculum guiding activities led by trained facilitators. Most interventions focused on changing social expectations and awareness, but few reported clear diffusion strategies to ensure the spread of the new norms and behaviours for the expected change. Key evidence gaps identified include integrating implementation research to inform the scale-up and sustainability of effective social norms interventions. Social norms interventions that effectively address the needs of high-risk adolescents and young people are needed.

A decade of PrEP: the evolution of HIV pre-exposure prophylaxis content and sentiments in South African print news media, 2012-2021

After nearly a decade of HIV pre-exposure prophylaxis (PrEP) rollout in sub-Saharan Africa, there has been limited study of PrEP messaging in news media. We selected twenty South African newspapers with the highest circulation volumes to retrieve articles published in 2012-2021 mentioning PrEP (N = 249). Using inductive content analysis, we developed a structured codebook to characterise PrEP-related content and sentiments, as well as their evolution over time, in the South African press. Many articles espoused favourable attitudes towards PrEP (52%), but a sizeable fraction espoused unfavourable attitudes (11%). Relative to PrEP-favourable articles, PrEP-unfavourable articles were significantly more likely to emphasise the drawbacks/consequences of PrEP use, including adherence/persistence requirements (52% vs. 24%, p = .007), cost (48% vs. 11%, p < .001), and risk compensation (52% vs. 5%, p < .001). Nevertheless, the presence of these drawbacks/consequences in print media largely declined over time. Key populations (e.g. adolescents, female sex workers) were frequently mentioned potential PrEP candidates. Despite message variations over time, prevention effectiveness and adherence/persistence requirements were the most widely cited PrEP benefits and drawbacks, respectively. Study findings demonstrate the dynamic nature of PrEP coverage in the South African press, likely in response to PrEP scale-up and real-world PrEP implementation during the study period.

Impact of sexual and reproductive health interventions among young people in sub-Saharan Africa: a scoping review

Objectives

The aim of this scoping review was to identify and provide an overview of the impact of sexual and reproductive health (SRH) interventions on reproductive health outcomes among young people in sub-Saharan Africa.

Methods

Searches were carried out in five data bases. The databases were searched using variations and combinations of the following keywords: contraception, family planning, birth control, young people and adolescents. The Cochrane risk-of-bias 2 and Risk of Bias in Non-Randomized Studies-of-Interventions tools were used to assess risk of bias for articles included.

Results

Community-based programs, mHealth, SRH education, counselling, community health workers, youth friendly health services, economic support and mass media interventions generally had a positive effect on childbirth spacing, modern contraceptive knowledge, modern contraceptive use/uptake, adolescent sexual abstinence, pregnancy and myths and misperceptions about modern contraception.

Conclusion

Sexual and reproductive health interventions have a positive impact on sexual and reproductive health outcomes. With the increasing popularity of mHealth coupled with the effectiveness of youth friendly health services, future youth SRH interventions could integrate both strategies to improve SRH services access and utilization.