Mobile sexual health services for adolescents: investigating the acceptability of youth-directed mobile clinic services in Cape Town, South Africa

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Abstract

Background

The Human Immunodeficiency Virus (HIV) epidemic is growing rapidly among South African adolescents and young adults (AYA). Although HIV counselling and testing, HIV prevention and treatment options are widely available, many AYA delay health-seeking until illness occurs, demonstrating a need for youth responsive, integrated sexual and reproductive health services (SRHS). While feasibility and cost-effectiveness have been evaluated, acceptability of mobile clinics among AYA has yet to be established. The objective of this study was to investigate patient acceptability of mobile AYA SRHS and compare mobile clinic usage and HIV outcomes with nearby conventional clinics.

Methods

Patients presenting to a mobile clinic in Cape Town were invited to participate in an acceptability study of a mobile clinic after using the service. A trained researcher administered an acceptability questionnaire. Mobile clinic medical records during the study period were compared with the records of AYA attending four clinics in the same community.

Results

Three hundred three enrolled participants (16–24 years, 246 (81.2%) female) rated mobile AYA SRHS acceptability highly (median = 4,6 out of 5), with 90% rating their experience as better or much better than conventional clinics. The mobile clinic, compared to conventional clinics, attracted more men (26% v 13%, p < 0,000), younger patients (18 v 19 years, p < 0,000), and yielded more HIV diagnoses (4% v 2%, p < 0,000).

Conclusions

Given the high ratings of acceptability, and the preference for mobile clinics over conventional primary health clinics, the scalability of mobile clinics should be investigated as part of a multipronged approach to improve the uptake of SRHS diagnostic, prevention and treatment options for AYA.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4423-4) contains supplementary material, which is available to authorized users.

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Most cited references 24

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Creating an enabling environment for adolescent sexual and reproductive health: a framework and promising approaches.

Joar Svanemyr, Avni Amin, Omar Robles … (2015)

This article provides a conceptual framework and points out the key elements for creating enabling environments for adolescent sexual and reproductive health (ASRH). An ecological framework is applied to organize the key elements of enabling environments for ASRH. At the individual level, strategies that are being implemented and seem promising are those that empower girls, build their individual assets, and create safe spaces. At the relationship level, strategies that are being implemented and seem promising include efforts to build parental support and communication as well as peer support networks. At the community level, strategies to engage men and boys and the wider community to transform gender and other social norms are being tested and may hold promise. Finally, at the broadest societal level, efforts to promote laws and policies that protect and promote human rights and address societal awareness about ASRH issues, including through mass media approaches, need to be considered.

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Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: the Cresting Wave

Brian C. Zanoni, Moherndran Archary, Sarah Buchan … (2016)

Context South Africa has the most HIV infections of any country in the world, yet little is known about the adolescent continuum of care from HIV diagnosis through viral suppression. Objective To determine the adolescent HIV continuum of care in South Africa. Data sources We searched PubMed, Google Scholar and online conference proceedings from International AIDS Society (IAS), International AIDS Conference (AIDS) and Conference on Retrovirology and Opportunistic Infections (CROI) from 1 January 2005 to 31 July 2015. Data extraction We selected published literature containing South African cohorts and epidemiological data reporting primary data for youth (15–24 years of age) at any stage of the HIV continuum of care (ie, diagnosis, treatment, retention, viral suppression). For the meta-analysis we used six sources for retention in care and nine for viral suppression. Results Among the estimated 867 283 HIV-infected youth from 15 to 24 years old in South Africa in 2013, 14% accessed antiretroviral therapy (ART). Of those on therapy, ∼83% were retained in care and 81% were virally suppressed. Overall, we estimate that 10% of HIV-infected youth in South Africa in 2013 were virally suppressed. Limitations This analysis relies on published data from large mostly urban South Africa cohorts limiting the generalisability to all adolescents. Conclusions Despite a large increase in ART programmes in South Africa that have relatively high retention rates and viral suppression rates among HIV-infected youth, only a small percentage are virally suppressed, largely due to low numbers of adolescents and young adults accessing ART.

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Barriers to and facilitators of the provision of a youth-friendly health services programme in rural South Africa

Rebecca Sally Geary, Francesc Xavier Gómez-Olivé, Kathleen Kahn … (2014)

Background Youth-friendly health services are a key strategy for improving young people’s health. This is the first study investigating provision of the Youth Friendly Services programme in South Africa since the national Department of Health took over its management in 2006. In a rural area of South Africa, we aimed to describe the characteristics of the publicly-funded primary healthcare facilities, investigate the proportion of facilities that provided the Youth Friendly Services programme and examine healthcare workers’ perceived barriers to and facilitators of the provision of youth-friendly health services. Methods Semi-structured interviews were conducted with nurses of all eight publicly-funded primary healthcare facilities in Agincourt sub-district, Mpumalanga Province, South Africa. Thematic analysis of interview transcripts was conducted and data saturation was reached. Results Participants largely felt that the Youth Friendly Services programme was not implemented in their primary healthcare facilities, with the exception of one clinic. Barriers to provision reported by nurses were: lack of youth-friendly training among staff and lack of a dedicated space for young people. Four of the eight facilities did not appear to uphold the right of young people aged 12 years and older to access healthcare independently. Breaches in young people’s confidentiality to parents were reported. Conclusions Participants reported that provision of the Youth Friendly Services programme is limited in this sub-district, and below the Department of Health’s target that 70% of primary healthcare facilities should provide these services. Whilst a dedicated space for young people is unlikely to be feasible or necessary, all facilities have the potential to be youth-friendly in terms of staff attitudes and actions. Training and on-going support should be provided to facilitate this; the importance of such training is emphasised by staff. More than one member of staff per facility should be trained to allow for staff turnover. As one of a few countrywide, government-run youth-friendly clinic programmes in a low or middle-income country, these results may be of interest to programme managers and policy makers in such settings.

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Author and article information

Contributors

Philip Smith:

ORCID: http://orcid.org/0000-0002-1458-8218

+27(0)21 6501895 , Philip.Smith@hiv-research.org.za

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 19 August 2019

Publication date PMC-release: 19 August 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 584

Affiliations

ISNI 0000 0004 1937 1151, GRID grid.7836.a, The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, , University of Cape Town, ; Anzio Road, Observatory, Cape Town, 7925 South Africa

Author information

Philip Smith http://orcid.org/0000-0002-1458-8218

Article

Publisher ID: 4423

DOI: 10.1186/s12913-019-4423-4

PMC ID: 6701080

PubMed ID: 31426788

SO-VID: 75e9f9cf-dc92-40be-a93f-67121de21da9

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 10 April 2019

Date accepted : 9 August 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001321, National Research Foundation;

Award ID: NA

Award Recipient : Philip Smith Tsidiso Tolla

Funded by: FundRef http://dx.doi.org/10.13039/100001316, Abbott Laboratories;

Award ID: NA

Funded by: FundRef http://dx.doi.org/10.13039/100004366, Chevron;

Award ID: NA

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ScienceOpen disciplines: Health & Social care

Keywords: acceptability,mobile clinic,epidemiology,usability,hiv,differentiated healthcare

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ScienceOpen disciplines: Health & Social care

Keywords: acceptability, mobile clinic, epidemiology, usability, hiv, differentiated healthcare

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Mobile sexual health services for adolescents: investigating the acceptability of youth-directed mobile clinic services in Cape Town, South Africa

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Most cited references 24

Creating an enabling environment for adolescent sexual and reproductive health: a framework and promising approaches.

Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: the Cresting Wave

Barriers to and facilitators of the provision of a youth-friendly health services programme in rural South Africa

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