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适应以社区为基础的性健康和生殖健康服务,以满足赞比亚卢萨卡 15-24 岁青少年和年轻人对 COVID-19 的需求:对接受艾滋病毒检测服务的影响。

Adapting community-based sexual and reproductive health services for adolescents and young people aged 15-24 years in response to COVID-19 in Lusaka, Zambia: the implications on the uptake of HIV testing services.

机构信息

Zambart, UNZA Ridgeway Campus, off Nationalist Road, Lusaka, Zambia.

Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.

出版信息

BMC Health Serv Res. 2022 Apr 14;22(1):503. doi: 10.1186/s12913-022-07878-7.


DOI:10.1186/s12913-022-07878-7
PMID:35421966
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9008386/
Abstract

BACKGROUND: Across Sub-Saharan Africa, adolescents and young people (AYP) aged 15-24 have limited access to sexual and reproductive health (SRH) services, including HIV testing services (HTS). In response, the Yathu Yathu study was implemented in two high-density communities in Lusaka, Zambia. Yathu Yathu provides comprehensive, community-based, peer-led SRH services, including differentiated HTS (finger-prick and HIV self-testing) and comprehensive sexuality education (CSE). We describe adaptations to the Yathu Yathu intervention in response to the COVID-19 epidemic, and implications on uptake of HTS among AYP. METHODS: Yathu Yathu provides SRH services through community-based peer-led spaces. AYP in study communities were offered prevention points cards (PPC), which incentivizes and tracks service use. Social media (WhatsApp©/Facebook©) is used to engage and inform AYP about SRH. Due to COVID-19, hubs closed from April-June 2020. We describe adaptations in response to COVID-19 and, using routinely collected PPC data, describe uptake of HTS before (September 2019-March 2020) and after (July-December 2020) adaptations in response to COVID-19. We describe reach of the Yathu Yathu Facebook page and use qualitative data to describe AYP experiences of SRH service access. RESULTS: During hub closures, CSE was delivered via video on social media, resulting in an increase in Facebook page followers from 539(April) to 891(June). WhatsApp groups evolved as a platform to deliver CSE and COVID-19 information, with higher participation among young people aged 20-24. Key service delivery adaptations included: reducing the number of participants in hubs, mandatory handwashing before entry, use of personal protective equipment by staff and provision of facemasks to AYP. HTS were provided as normal. Adaptations led to fewer AYP attending hubs. Uptake of HTS among AYP visiting hubs for the first time after COVID-19-related closures was higher (73.2%) compared to uptake before adaptations (65.9%; adjOR=1.24 95%CI 0.99, 1.56, p=0.06). Despite disappointments with some aspects of service delivery, AYP expressed happiness that hubs had reopened. CONCLUSIONS: Social media can be a useful additional platform to reach AYP with HIV prevention information during COVID-19. With proper infection control in place, HTS can safely be provided to, accessed and accepted by AYP in community-based settings during COVID-19. TRIAL REGISTRATION: National Clinical Trials NCT04060420,19 August 2019. Current Controlled Trials ISRCTN75609016 , 14 September 2021, retrospectively registered.

摘要

背景:在撒哈拉以南非洲地区,15-24 岁的青少年和年轻人(AYP)获得性与生殖健康(SRH)服务,包括艾滋病毒检测服务(HTS)的机会有限。针对这一问题,Yathu Yathu 研究在赞比亚卢萨卡的两个高密度社区实施。Yathu Yathu 提供全面的、以社区为基础的、由同龄人领导的 SRH 服务,包括差异化 HTS(指尖和 HIV 自我检测)和全面性教育(CSE)。我们描述了针对 Yathu Yathu 干预措施的调整,以应对 COVID-19 疫情,并介绍了这些调整对 AYP 接受 HTS 的影响。

方法:Yathu Yathu 通过以社区为基础的同龄人领导的空间提供 SRH 服务。研究社区中的 AYP 提供预防点卡(PPC),以激励和跟踪服务使用情况。社交媒体(WhatsApp©/Facebook©)用于与 AYP 互动并告知他们有关 SRH 的信息。由于 COVID-19,中心从 2020 年 4 月至 6 月关闭。我们描述了针对 COVID-19 的调整,并使用常规收集的 PPC 数据,描述了在针对 COVID-19 的调整之前(2019 年 9 月至 2020 年 3 月)和之后(2020 年 7 月至 12 月)接受 HTS 的情况。我们描述了 Yathu Yathu Facebook 页面的覆盖范围,并使用定性数据描述了 AYP 对 SRH 服务获取的体验。

结果:在中心关闭期间,通过社交媒体上的视频提供了 CSE,导致 Facebook 页面关注者从 4 月的 539 人增加到 6 月的 891 人。WhatsApp 群组演变为提供 CSE 和 COVID-19 信息的平台,20-24 岁的年轻人参与度更高。关键的服务提供调整包括:减少中心的参与者人数,进入前必须洗手,工作人员使用个人防护设备,并向 AYP 提供口罩。HTS 正常提供。调整导致更少的 AYP 参加中心。在 COVID-19 相关关闭后首次访问中心的 AYP 接受 HTS 的比例较高(73.2%),高于调整前(65.9%;调整后的 OR=1.24,95%CI 0.99,1.56,p=0.06)。尽管对一些服务提供方面感到失望,但 AYP 表示很高兴中心重新开放。

结论:在 COVID-19 期间,社交媒体可以成为向 AYP 提供 HIV 预防信息的有用补充平台。在适当的感染控制措施到位的情况下,HTS 可以在 COVID-19 期间安全地提供、接受并被社区环境中的 AYP 接受。

试验注册:国家临床试验 NCT04060420,2019 年 8 月 19 日。当前对照试验 ISRCTN75609016,2021 年 9 月 14 日,回顾性注册。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f42a/9008942/252a66a68395/12913_2022_7878_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f42a/9008942/252a66a68395/12913_2022_7878_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f42a/9008942/252a66a68395/12913_2022_7878_Fig1_HTML.jpg

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[7]
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[8]
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本文引用的文献

[1]
Yathu Yathu ("For us, by us"): Design of a cluster-randomised trial of the impact of community-based, peer-led comprehensive sexual and reproductive health services for adolescents and young people aged 15 to 24 in Lusaka, Zambia.

Contemp Clin Trials. 2021-11

[2]
Engaging young people in the design of a sexual reproductive health intervention: Lessons learnt from the Yathu Yathu ("For us, by us") formative study in Zambia.

BMC Health Serv Res. 2021-7-29

[3]
Uptake of HIV Testing Services Through Novel Community-Based Sexual and Reproductive Health Services: An Analysis of the Pilot Implementation Phase of the Yathu Yathu Intervention for Adolescents and Young People Aged 15-24 in Lusaka, Zambia.

AIDS Behav. 2022-1

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Adolescent girls, a forgotten population in resource-limited settings in the COVID-19 pandemic: implications for sexual and reproductive health outcomes.

Pan Afr Med J. 2020

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Acta Obstet Gynecol Scand. 2021-4

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AIDS. 2021-2-2

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Lancet. 2020-8-1

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AIDS Behav. 2020-11

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