Department of Family, Population and Preventive Medicine, HSC Level 3, Room 79 Stony Brook University (State University of New York), Stony Brook, NY, 11794, USA.
UNICEF Office of Research - Innocenti, Via degli Alfani 58, 50121, Florence, Italy.
BMC Health Serv Res. 2020 Sep 17;20(1):881. doi: 10.1186/s12913-020-05731-3.
HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact.
The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents' uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services.
Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexually-active adolescents.
We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence.
艾滋病毒检测在青少年中仍然很低。使公共卫生服务更适合青少年是鼓励检测的一种策略。然而，政府主导的倡议是否具有有意义的影响尚不清楚。
本研究是观察性的，利用了正在进行的一项针对青少年的试点现金加方案的纵向影响评估的一轮数据收集的两个数据源（卫生机构和青少年层面）。这项研究将来自青少年调查（n=2191）的数据与来自坦桑尼亚两个农村地区附近政府经营的卫生机构（n=91）收集的数据联系起来。我们使用对数二项式回归模型来估计特定的青少年友好型卫生服务（AFHS）特征与青少年接受以下两项服务的可能性之间的关联：1）艾滋病毒检测和 2）在过去一年中为性健康和生殖健康（SRH）服务而前往卫生保健机构。
大多数青少年（67%）居住在有卫生机构的村庄，并且所有村庄都提供艾滋病毒服务。然而，我们发现 AFHS 并未得到充分实施。例如，不到 40%的机构报告说他们有青少年护理指南。只有 12%的机构建立了针对青少年客户的转介和后续系统，但这是过去一年进行艾滋病毒检测（RR=1.28，p<0.1）和进行 SRH 就诊（RR=1.44，p<0.05）的重要预测因素。不到一半（44%）提供性别暴力（GBV）幸存者服务，这是过去一年进行艾滋病毒检测（RR=1.20，p<0.05）和进行 SRH 就诊（RR=1.41，p<0.01）的重要预测因素活跃的青少年。
我们发现，国家关于 AFHS 的准则在地方一级尚未完全付诸实践。我们强调了青少年转介系统和 GBV 服务方面的特别差距。扩大这两项基本服务可以鼓励高危人群进行更多的艾滋病毒检测，同时为暴力幸存者提供急需的支持。
