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Mbengo F, Adama E, Towell-Barnard A, Bhana A, Zgambo M. Barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide: a systematic review. BMC Infect Dis 2022; 22:679. [PMID: 35941562 PMCID: PMC9361597 DOI: 10.1186/s12879-022-07649-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions aimed at reducing risky sexual behavior are considered an important strategy for averting Human Immunodeficiency Virus (HIV) infection among youth (15-24 years) who continue to be at risk of the disease. Enhancing intervention success requires a comprehensive understanding of the barriers and facilitators to interventions targeting youth. However, there is lack of a systematic review of both quantitative and qualitative studies to comprehensively identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide. This review aimed to identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth globally based on original peer-reviewed studies published in the last decade. METHODS The Joanna Briggs Institute approach for mixed methods systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to guide this review. Nine electronic databases, Joint United Nations Programme on HIV/AIDS and World Health Organization websites, and reference lists of included studies and systematic reviews on barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth were searched for eligible articles. Studies that met the inclusion criteria underwent quality appraisal and data extraction. Findings were analyzed using thematic synthesis and underpinned by Nilsen, 2015's Determinant Framework. RESULTS Overall 13 studies comprising of eight qualitative studies, four quantitative studies and one mixed methods study were included in the review. Several barriers and facilitators across the five Determinant Framework domains were identified. Most of the barriers fell under the characteristics of the context domain (e.g., gender-biased norms). The next important group of barriers emerged within the characteristics of the end users domain (e.g., fear of relationship breakdown). In terms of facilitators, the majority fell under the characteristics of the strategy of facilitating implementation domain (e.g., implementation of intervention with fidelity) and characteristics of the end users domain (e.g., fear of pregnancy or sexually transmitted infections). The next common set of facilitators appeared within the characteristics of the context domain (e.g., family support). CONCLUSION This review identified several multi-level barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth. Multi-level and combination approaches are needed to address these factors and enhance intervention success.
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Affiliation(s)
- Fungai Mbengo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia.
| | - Esther Adama
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
| | - Arvin Bhana
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Maggie Zgambo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
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Sandøy IF, Mudenda M, Zulu J, Munsaka E, Blystad A, Makasa MC, Mæstad O, Tungodden B, Jacobs C, Kampata L, Fylkesnes K, Svanemyr J, Moland KM, Banda R, Musonda P. Effectiveness of a girls' empowerment programme on early childbearing, marriage and school dropout among adolescent girls in rural Zambia: study protocol for a cluster randomized trial. Trials 2016; 17:588. [PMID: 27938375 PMCID: PMC5148869 DOI: 10.1186/s13063-016-1682-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Adolescent pregnancies pose a risk to the young mothers and their babies. In Zambia, 35% of young girls in rural areas have given birth by the age of 18 years. Pregnancy rates are particularly high among out-of-school girls. Poverty, low enrolment in secondary school, myths and community norms all contribute to early childbearing. This protocol describes a trial aiming to measure the effect on early childbearing rates in a rural Zambian context of (1) economic support to girls and their families, and (2) combining economic support with a community intervention to enhance knowledge about sexual and reproductive health and supportive community norms. Methods/design This cluster randomized controlled trial (CRCT) will have three arms. The clusters are rural schools with surrounding communities. Approximately 4900 girls in grade 7 in 2016 will be recruited from 157 schools in 12 districts. In one intervention arm, participating girls and their guardians will be offered cash transfers and payment of school fees. In the second intervention arm, there will be both economic support and a community intervention. The interventions will be implemented for approximately 2 years. The final survey will be 4.5 years after recruitment. The primary outcomes will be “incidence of births within 8 months of the end of the intervention period”, “incidence of births before girls’ 18th birthday” and “proportion of girls who sit for the grade 9 exam”. Final survey interviewers will be unaware of the intervention status of respondents. Analysis will be by intention-to-treat and adjusted for cluster design and confounders. Qualitative process evaluation will be conducted. Discussion This is the first CRCT to measure the effect of combining economic support with a community intervention to prevent adolescent childbearing in a low- or middle-income country. We have designed a programme that will be sustainable and feasible to scale up. The findings will be relevant for programmes for adolescent reproductive health in Zambia and similar contexts. Trial registration ISRCTN registry: ISRCTN12727868, (4 March 2016). Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1682-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingvild Fossgard Sandøy
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway. .,Centre for International Health, University of Bergen, Bergen, Norway. .,Department of Global Public Health and Primary Care (IGS), University of Bergen, Bergen, Norway.
| | - Mweetwa Mudenda
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Joseph Zulu
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Ecloss Munsaka
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Department of Educational Psychology, School of Education, University of Zambia, Lusaka, Zambia
| | - Astrid Blystad
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Centre for International Health, University of Bergen, Bergen, Norway.,Department of Global Public Health and Primary Care (IGS), University of Bergen, Bergen, Norway
| | - Mpundu C Makasa
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Ottar Mæstad
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Christian Michelsens Institute, Bergen, Norway
| | - Bertil Tungodden
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Christian Michelsens Institute, Bergen, Norway.,Norwegian School of Economics, Bergen, Norway
| | - Choolwe Jacobs
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Linda Kampata
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Centre for International Health, University of Bergen, Bergen, Norway.,Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Knut Fylkesnes
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Joar Svanemyr
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Centre for International Health, University of Bergen, Bergen, Norway.,Christian Michelsens Institute, Bergen, Norway
| | - Karen Marie Moland
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Richard Banda
- Centre for International Health, University of Bergen, Bergen, Norway.,Central Statistical Office, Zambia, Lusaka, Zambia
| | - Patrick Musonda
- Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway.,Centre for International Health, University of Bergen, Bergen, Norway.,Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
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Capurchande R, Coene G, Schockaert I, Macia M, Meulemans H. "It is challenging… oh, nobody likes it!": a qualitative study exploring Mozambican adolescents and young adults' experiences with contraception. BMC WOMENS HEALTH 2016; 16:48. [PMID: 27475909 PMCID: PMC4967333 DOI: 10.1186/s12905-016-0326-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/22/2016] [Indexed: 11/23/2022]
Abstract
Background By focusing upon formal sex education programmes, the Mozambican government has significantly enhanced the general health of adolescents and young adults. However, when it comes to contraception, little is known about how adolescents and young adults actually behave. Methods Based upon a qualitative study in two settings in Maputo province – Ndlavela and Boane – this paper explores the knowledge and practices of contraception among adolescents and young adults. A total of four focus group discussions, 16 in-depth interviews, four informal conversations, and observations were equally divided between both study sites. Results Discrepancies between what adolescents and young adults know and what they do quickly became evident. Ambivalent and contradictory practices concerning contraceptive use was the result. As well, young people had numerous interpretations of risk-taking when not using contraceptives. These inconsistencies are influenced by social and medical barriers such as restricted dialogue on sexuality among adolescents and young adults and their parents and peers. Additionally, ideas about indigenous contraceptives, notions of masculinity and femininity, misconceptions and fear of the side effects of contraceptives, make people of all ages wary of modern birth control. Other barriers include imposed contraceptive choice – meaning no choice, overly technical medical language used at clinics and the absence of healthcare workers more attuned to the needs of adolescents and young adults. Conclusions Adolescents and young adults have numerous – often erroneous – opinions about contraception, leading to inconsistent use as well as vague perceptions of risk-taking. Moreover, social norms and cultural gender roles often contradict and hinder risk-avoiding behaviour. Therefore, in order to improve young people’s health, policymakers must address the reasons behind this ambivalence and inconsistency.
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Affiliation(s)
- Rehana Capurchande
- Department of Sociology, Eduardo Mondlane University- Maputo, Campus Universitário Principal. CP 257, Maputo, Mozambique. .,Vrije Universiteit Brussel (Free University of Brussels), Centre for Research in Gender and Diversity, Department of Sociology, Faculty of Economic and Social Science, and Solvay Business School, Free University of Brussels, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Gily Coene
- Vrije Universiteit Brussel (Free University of Brussels), Department of Philosophy and Ethics, Centre for Research in Gender and Diversity, Pleinlaan 2, B-1050, Brussels, Belgium
| | - Ingrid Schockaert
- Department of Sociology, Faculty of Economic and Social Science, and Solvay Business School, Free University of Brussels, Pleinlaan 5, 1050, Brussels, Belgium
| | - Manuel Macia
- Department of Sociology, Faculty of Arts and Social Sciences, Eduardo Mondlane University, Praça 25 de Junho, C. Postal 257, Maputo, Mozambique
| | - Herman Meulemans
- Universiteit Antwerpen (Antwerp University), Department of Sociology, Centre for Longitudinal and Life Course Studies, Sint-Jacobstraat 2, BE-2000, Antwerpen, Belgium.,Centre for Health Systems Research and Development (CHSR&D), University of the Free State, Bloemfontein, South Africa
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