Family Health, Ministry of Health and Child Care, Harare, Zimbabwe
Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.
BMJ Open. 2020 Mar 8;10(3):e034436. doi: 10.1136/bmjopen-2019-034436.
Peer education is an intervention within the voluntary medical male circumcision (VMMC)-adolescent sexual reproductive health (ASRH) linkages project in Bulawayo and Mount Darwin, Zimbabwe since 2016. Little is known if results extend beyond increasing knowledge. We therefore assessed the extent of and factors affecting referral by peer educators and receipt of HIV testing services (HTS), contraception, management of sexually transmitted infections (STIs) and VMMC services by young people (10-24 years) counselled.
A cohort study involving all young people counselled by 95 peer educators during October-December 2018, through secondary analysis of routinely collected data.
All ASRH and VMMC sites in Mt Darwin and Bulawayo.
All young people counselled by 95 peer educators.
Censor date for assessing receipt of services was 31 January 2019. Factors (clients' age, gender, marital and schooling status, counselling type, location, and peer educators' age and gender) affecting non-referral and non-receipt of services (dependent variables) were assessed by log-binomial regression. Adjusted relative risks (aRRs) were calculated.
Of the 3370 counselled (66% men), 65% were referred for at least one service. 58% of men were referred for VMMC. Other services had 5%-13% referrals. Non-referral for HTS decreased with clients' age (aRR: ~0.9) but was higher among group-counselled (aRR: 1.16). Counselling by men (aRR: 0.77) and rural location (aRR: 0.61) reduced risks of non-referral for VMMC, while age increased it (aRR ≥1.59). Receipt of services was high (64%-80%) except for STI referrals (39%). Group counselling and rural location (aRR: ~0.52) and male peer educators (aRR: 0.76) reduced the risk of non-receipt of VMMC. Rural location increased the risk of non-receipt of contraception (aRR: 3.18) while marriage reduced it (aRR: 0.20).
We found varying levels of referral ranging from 5.1% (STIs) to 58.3% (VMMC) but high levels of receipt of services. Type of counselling, peer educators' gender and location affected receipt of services. We recommend qualitative approaches to further understand reasons for non-referrals and non-receipt of services.
同伴教育是津巴布韦布拉瓦约和达尔文山志愿男性包皮环切（VMMC）-青少年性生殖健康（ASRH）项目中的一项干预措施，自 2016 年以来一直在实施。目前尚不清楚这些结果是否会超出增加知识的范围。因此，我们评估了同伴教育者转介的程度和影响因素，以及接受艾滋病毒检测服务（HTS）、避孕、性传播感染（STI）管理和 VMMC 服务的年轻人（10-24 岁）的情况。
这是一项队列研究，涉及 2018 年 10 月至 12 月期间通过 95 名同伴教育者对所有年轻人进行的咨询，通过对常规收集数据的二次分析进行评估。
达尔文山和布拉瓦约的所有 ASRH 和 VMMC 地点。
所有接受 95 名同伴教育者咨询的年轻人。
评估服务接受情况的截止日期为 2019 年 1 月 31 日。通过逻辑二进制回归评估影响非转诊和非服务接受（因变量）的因素（客户年龄、性别、婚姻和教育状况、咨询类型、地点以及同伴教育者的年龄和性别）。计算调整后的相对风险（aRR）。
在 3370 名接受咨询的年轻人中（66%为男性），65%被转介接受至少一项服务。58%的男性被转介接受 VMMC。其他服务的转诊率为 5%-13%。接受 HTS 检测的人数随着客户年龄的增长而减少（aRR：0.9），但群体咨询（aRR：1.16）的人数却增加了。男性咨询（aRR：0.77）和农村地区（aRR：0.61）降低了 VMMC 转介的风险，而年龄增加了风险（aRR≥1.59）。服务的接受率很高（64%-80%），除了 STI 转诊（39%）。群体咨询和农村地区（aRR：0.52）以及男性同伴教育者（aRR：0.76）降低了 VMMC 未接受服务的风险。农村地区增加了未接受避孕措施的风险（aRR：3.18），而婚姻则降低了这种风险（aRR：0.20）。
我们发现转诊率从 5.1%（STIs）到 58.3%（VMMC）不等，但服务接受率很高。咨询类型、同伴教育者的性别和地点影响服务的接受情况。我们建议采用定性方法进一步了解未转诊和未接受服务的原因。
