*Pathfinder International, Watertown, MA; †Technical Division, Sexual and Reproductive Health Branch, United Nations Population Fund, New York, NY; and ‡Partners in Expanding Health Quality and Access and ExpandNet Secretariat, Davis, CA.
J Acquir Immune Defic Syndr. 2014 Jul 1;66 Suppl 2:S200-8. doi: 10.1097/QAI.0000000000000180.
Poor sexual and reproductive health outcomes among adolescents aged 10-19 years are indicative of the barriers this group faces in accessing health services and highlights a gap in the availability of appropriate services, including adolescent-friendly contraceptive services (AFCS). The HIV Investment Framework identifies contraceptive services as an entry point for HIV counseling, testing, and treatment, and as a component of HIV prevention. To effectively meet the needs of adolescents, greater understanding of effective scale-up strategies for adolescent-friendly services is needed.
The authors conducted a retrospective analysis of AFCS scale-up experiences in Ethiopia, Ghana, Mozambique, Tanzania, and Vietnam using the ExpandNet/World Health Organization framework for systematic scale-up. The authors analyzed the type of scale (expansion or institutionalization), dissemination and advocacy, organizational process, costs and resource mobilization, and monitoring and evaluation.
The analysis showed that all programs simultaneously pursued expansion and institutionalization, contributing to sustainable scale-up. Advocacy complemented by intensive capacity building at all levels of the health system contributed to adoption of AFCS in national and district work plans and budgets as well strengthening collection of age-disaggregated data.
To achieve scale-up of AFCS, the authors identified the importance of institutionalization and expansion in tandem for synergy and reinforcement, empowering adolescents to be agents of change and hold government accountable to its commitments, and strengthening health systems to sustain AFCS.
This article contributes to a growing body of evidence around scale-up of AFCS, which can inform the implementation and sustainable scale-up of HIV and other services for adolescents.
10-19 岁青少年的性健康和生殖健康状况不佳表明，该人群在获得卫生服务方面面临障碍，这也凸显了适当服务（包括青少年友好型避孕服务）供应不足的问题。《艾滋病毒投资框架》将避孕服务确定为艾滋病毒咨询、检测和治疗的切入点，也是艾滋病毒预防的组成部分。为了有效满足青少年的需求，需要更好地了解扩大青少年友好服务的有效策略。
作者利用 ExpandNet/世界卫生组织系统扩大规模框架，对埃塞俄比亚、加纳、莫桑比克、坦桑尼亚和越南的青少年友好型避孕服务扩大规模经验进行了回顾性分析。作者分析了扩大规模的类型（扩展或制度化）、传播和宣传、组织流程、成本和资源调动以及监测和评估。
分析表明，所有方案都同时追求扩展和制度化，从而促进可持续扩大规模。在各级卫生系统开展宣传和强化能力建设，有助于将青少年友好型避孕服务纳入国家和地区工作计划和预算，并加强年龄分类数据的收集。
为了实现青少年友好型避孕服务的扩大规模，作者确定了制度化和扩展的重要性，以实现协同和强化，使青少年能够成为变革的推动者，并使政府对其承诺负责，同时加强卫生系统以维持青少年友好型避孕服务。
本文为扩大青少年友好型避孕服务规模的证据体系做出了贡献，为实施和可持续扩大艾滋病毒及其他青少年服务提供了信息。
