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

Philip Smith, Tsidiso Tolla, Rebecca Marcus, Linda-Gail Bekker, Philip Smith, Tsidiso Tolla, Rebecca Marcus, Linda-Gail Bekker

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.

Keywords: Acceptability; Differentiated healthcare; Epidemiology; HIV; Mobile clinic; Usability.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Bekker L-G, Johnson L, Wallace M, Hosek S. Building our youth for the future. J Int AIDS Soc. 2015;18(2 Suppl 1):20027.
    1. Black S, Wallace M, Middelkoop K, Robbertze D, Bennie T, Wood R, et al. Improving HIV testing amongst adolescents through an integrated Youth Centre rewards program: Insights from South Africa. Child Youth Serv Rev. 2014; Available from: . [cited 2014 Jun 4].
    1. Geary RS, Gómez-Olivé FX, Kahn K, Tollman S, Norris SA. Barriers to and facilitators of the provision of a youth-friendly health services programme in rural South Africa. BMC Health Serv Res. 2014;14(1):259. doi: 10.1186/1472-6963-14-259.
    1. Geary Rebecca S., Webb Emily L., Clarke Lynda, Norris Shane A. Evaluating youth-friendly health services: young people's perspectives from a simulated client study in urban South Africa. Global Health Action. 2015;8(1):26080. doi: 10.3402/gha.v8.26080.
    1. Svanemyr J, Amin A, Robles OJ, Greene ME. Creating an enabling environment for adolescent sexual and reproductive health: a framework and promising approaches. J Adolesc Health. 2015;56(1, Supplement):S7–14. doi: 10.1016/j.jadohealth.2014.09.011.
    1. James S, Pisa PT, Imrie J, Beery MP, Martin C, Skosana C, et al. Assessment of adolescent and youth friendly services in primary healthcare facilities in two provinces in South Africa. BMC Health Serv Res. 2018;18(1):809. doi: 10.1186/s12913-018-3623-7.
    1. Strauss M, Rhodes B, George G. A qualitative analysis of the barriers and facilitators of HIV counselling and testing perceived by adolescents in South Africa. BMC Health Serv Res. 2015;15:250. doi: 10.1186/s12913-015-0922-0.
    1. Dickson-Tetteh K, Pettifor A, Moleko W. Working with public sector clinics to provide adolescent-friendly services in South Africa. Reprod Health Matters. 2001;9(17):160–169. doi: 10.1016/S0968-8080(01)90020-5.
    1. Hosek S, Celum C, Wilson CM, Kapogiannis B, Delany-Moretlwe S, Bekker L-G. Preventing HIV among adolescents with oral PrEP: observations and challenges in the United States and South Africa. J Int AIDS Soc. 2016;19(7Suppl 6) Available from: . [cited 2017 Apr 3].
    1. Wood K, Jewkes R. Blood blockages and scolding nurses: barriers to adolescent contraceptive use in South Africa. Reprod Health Matters. 2006;14(27):109–118. doi: 10.1016/S0968-8080(06)27231-8.
    1. Pettifor A, Bekker L-G, Hosek S, DiClemente R, Rosenberg M, Bull S, et al. Preventing HIV among Young People: research priorities for the future. J Acquir Immune Defic Syndr 1999. 2013;63(0 2):S155–S160. doi: 10.1097/QAI.0b013e31829871fb.
    1. Victor EC, Hariri AR. A neuroscience perspective on sexual risk behavior in adolescence and emerging adulthood. Dev Psychopathol. 2016;28(2):471–487. doi: 10.1017/S0954579415001042.
    1. Simbayi LC, Chauveau J, Shisana O. Behavioural responses of south African youth to the HIV/AIDS epidemic: a nationwide survey. AIDS Care. 2004;16(5):605–618. doi: 10.1080/09540120410001716405.
    1. Zuma K, Setswe G, Ketye Y, Mzolo T, Rehle T, Mbelle N. Age at sexual debut: a determinant of multiple partnership among south African youth. Afr J Reprod Health. 2014;14(2):47–54.
    1. Barnabas SL, Jaspan HB, Dabee S, Jaumdally SZ, Gamieldien H, Lewis D, et al. Knowing whom we are trying to protect: an assessment of HIV risk in south African adolescent females. AIDS Res Hum Retrovir. 2014;30(S1):A131. doi: 10.1089/aid.2014.5260.abstract.
    1. Mkhwanazi N. A tough love approach indeed: Demonising early childbearing in the Zuma era. Agenda. 2012;26(4):73–84. doi: 10.1080/10130950.2012.759440.
    1. Christofides Nicola J, Jewkes Rachel K, Dunkle Kristin L, Nduna Mzikazi, Shai Nwabisa Jama, Sterk Claire. Early adolescent pregnancy increases risk of incident HIV infection in the Eastern Cape, South Africa: a longitudinal study. Journal of the International AIDS Society. 2014;17(1):18585. doi: 10.7448/IAS.17.1.18585.
    1. Macleod CI, Tracey T. A decade later: follow-up review of south African research on the consequences of and contributory factors in teen-aged pregnancy. South Afr J Psychol. 2010;40(1):18–31. doi: 10.1177/008124631004000103.
    1. Williams BG, Gupta S, Wollmers M, Granich R. Progress and prospects for the control of HIV and tuberculosis in South Africa: a dynamical modelling study. Lancet Public Health. 2017;2(5):e223–e230. doi: 10.1016/S2468-2667(17)30066-X.
    1. Delany-Moretlwe S, Cowan FM, Busza J, Bolton-Moore C, Kelley K, Fairlie L. Providing comprehensive health services for young key populations: needs, barriers and gaps. J Int AIDS Soc. 2015;18(2Suppl 1) Available from: . [cited 2015 Aug 12].
    1. Dellar RC, Dlamini S, Karim QA. Adolescent girls and young women: key populations for HIV epidemic control. J Int AIDS Soc. 2015;18(2Suppl 1) Available from: . [cited 2015 Aug 19].
    1. Moodley N, Gray G, Bertram M. The case for adolescent HIV vaccination in South Africa: a cost-effectiveness analysis. Medicine (Baltimore) 2016;95(4):e2528. doi: 10.1097/MD.0000000000002528.
    1. Shisana O, Rehle T, Simbayi L, Zuma K, Jooste S, Zungu N. South African national HIV prevalence, incidence and behaviour survey, 2012. Cape Town: HSRC Press; 2014.
    1. Goldenberg JL, Arndt J, Hart J, Routledge C. Uncovering an existential barrier to breast self-exam behavior. J Exp Soc Psychol. 2008;44(2):260–274. doi: 10.1016/j.jesp.2007.05.002.
    1. Govindasamy D, Ford N, Kranzer K. Risk factors, barriers and facilitators for linkage to antiretroviral therapy care: a systematic review. AIDS. 2012;26(16):2059–2067. doi: 10.1097/QAD.0b013e3283578b9b.
    1. Mulaudzi M, Dlamini BN, Coetzee J, Sikkema K, Gray G, Dietrich JJ. Perceptions of counsellors and youth-serving professionals about sexual and reproductive health services for adolescents in Soweto, South Africa. Reprod Health. 2018;15(1):21. doi: 10.1186/s12978-018-0455-1.
    1. Bastani P, Hogg RS, Marshall B, Montaner JSG, Ramadanovic B, Rutherford AR, et al. Highly active antiretroviral therapy eliminates HIV epidemics in a ! Network model of an injecting drug user community ! Group. 2010. p. 2010.
    1. Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, de Walque D, et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS Lond Engl. 2011;25(6):825–834. doi: 10.1097/QAD.0b013e32834380c1.
    1. Velasco-Hernandez JX, Gershengorn HB, Blower SM. Could widespread use of combination antiretroviral therapy eradicate HIV epidemics? Lancet Infect Dis. 2002;2(8):487–493. doi: 10.1016/S1473-3099(02)00346-8.
    1. Zanoni BC, Archary M, Buchan S, Katz IT, Haberer JE. Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: the cresting wave. BMJ Glob Health. 2016;1(3):e000004. doi: 10.1136/bmjgh-2015-000004.
    1. Dickson KE, Ashton J, Smith J-M. Does setting adolescent-friendly standards improve the quality of care in clinics? Evidence from South Africa. Int J Qual Health Care. 2007;19(2):80–89. doi: 10.1093/intqhc/mzl070.
    1. WHO . Making health services adolescent friendly: Developing national quality standards for adolescent friendly health services. 2012.
    1. Tylee A, Haller DM, Graham T, Churchill R, Sanci LA. Youth-friendly primary-care services: how are we doing and what more needs to be done? Lancet. 2007;369(9572):1565–1573. doi: 10.1016/S0140-6736(07)60371-7.
    1. Govindasamy Darshini, Ferrand Rashida A, Wilmore Stephanie MS, Ford Nathan, Ahmed Saeed, Afnan-Holmes Hoviyeh, Kranzer Katharina. Uptake and yield of HIV testing and counselling among children and adolescents in sub-Saharan Africa: a systematic review. Journal of the International AIDS Society. 2015;18(1):20182. doi: 10.7448/IAS.18.1.20182.
    1. van Schaik N, Kranzer K, Wood R, Bekker L-G. Earlier HIV diagnosis--are mobile services the answer? South Afr Med J Suid-Afr Tydskr Vir Geneeskd. 2010;100(10):671–674.
    1. Bassett IV, Govindasamy D, Erlwanger A, van Schaik N, Noubary F, Wood R, et al. Mobile HIV screening very cost effective in South Africa. PharmacoEconomics Outcomes News. 2013;676(1):10.
    1. Maheswaran H, Thulare H, Stanistreet D, Tanser F, Newell M-L. Starting a home and mobile HIV testing service in a rural area of South Africa. J Acquir Immune Defic Syndr 1999. 2012;59(3):e43–e46. doi: 10.1097/QAI.0b013e3182414ed7.
    1. Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015;528(7580):S77–S85. doi: 10.1038/nature16044.
    1. van Rooyen H, McGrath N, Chirowodza A, Joseph P, Fiamma A, Gray G, et al. Mobile VCT: reaching men and young people in urban and rural south African pilot studies (NIMH project accept, HPTN 043) AIDS Behav. 2013;17(9):2946–2953. doi: 10.1007/s10461-012-0368-x.
    1. HSRC. The fifth south African national HIV prevalence, incidence, behaviour and communication survey, 2017: HIV impact assessment summary report. 2018. Available from: . [cited 2018 Sep 13].
    1. Smith P, Marcus R, Bennie T, Nkala B, Nchabeleng M, Latka MH, et al. What do south African adolescents want in a sexual health service? Evidence from the south African studies on HIV in adolescents (SASHA) project. S Afr Med J. 2018;108(8):677–681. doi: 10.7196/SAMJ.2018.v108i8.13013.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren