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Hémono R, Gatare E, Kayitesi L, Packel L, Hunter LA, Kunesh J, Mwali MM, Bertozzi S, Sayinzoga F, Mugisha M, Hope R, McCoy SI. CyberRwanda's Pathway to Impact: Results From a Cluster-Randomized Trial of Adolescent Family Planning Knowledge, Beliefs, Self-Efficacy, and Behavior. J Adolesc Health 2024; 74:1239-1248. [PMID: 38506778 DOI: 10.1016/j.jadohealth.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE CyberRwanda is a digital health intervention designed to increase knowledge of family planning and reproductive health (FP/RH) and access to youth-friendly services in Rwanda. METHODS Sixty schools in eight districts were randomized 1:1:1 to one of two CyberRwanda implementation models-self-service (tablet-only) or facilitated (tablet, activity booklet, peer facilitators)-or to control. Students aged 12-19 years were randomly selected to participate. Baseline and 12-month midline surveys assessed intermediate (secondary) outcomes of FP/RH and HIV knowledge, attitudes/beliefs, self-efficacy, and behavior. Prevalence differences (PDs) were estimated using generalized linear mixed models. RESULTS There were 5,767 midline participants (51% female, mean/median age: 16 years, 29.9% sexually active). Those in CyberRwanda schools had higher knowledge of emergency contraception (57.3% vs. 47.5%, PD: 0.09, 95% confidence interval [CI]: 0.05-0.13); greater confidence in providing consent (73.3% vs. 68.1%, PD: 0.05, 95% CI: 0.01-0.08), negotiating partner's contraceptive use (88.3% vs. 85.0%, PD: 0.03, 95% CI: 0.01-0.06), and accessing/using contraceptive services (95.6% vs. 91.8%, PD: 0.03, 95% CI: 0.02-0.05); and more favorable views on FP/RH services (54.5% vs. 48.5%, PD: 0.06, 95% CI: 0.02-0.11) and condoms (76.9% vs. 71.3%, PD: 0.06, 95% CI: 0.03-0.08) compared to control. No significant differences in HIV/fertility knowledge, confidence in accessing HIV testing, or condom use were observed. DISCUSSION CyberRwanda increased FP/RH knowledge, supportive attitudes/beliefs, self-efficacy, and behavior at 12 months. The 24-month endline analysis will reveal whether CyberRwanda's benefits on intermediate outcomes result in changes to the primary outcomes, including contraception use and childbearing.
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Affiliation(s)
- Rebecca Hémono
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, California.
| | | | | | - Laura Packel
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, California
| | - Lauren A Hunter
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, California
| | - Jacqueline Kunesh
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, California
| | | | - Stefano Bertozzi
- Division of Health Policy and Management, University of California, Berkeley, School of Public Health, Berkeley, California
| | | | - Michael Mugisha
- University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
| | - Rebecca Hope
- Youth Development Labs (YLabs), Berkeley, California
| | - Sandra I McCoy
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, California
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Adal MA, Abiy SA, Reta MM, Asres MS, Animut Y. Prevalence of risky sexual behavior and associated factors among Injibara University students, Northwest Ethiopia. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1356790. [PMID: 38605815 PMCID: PMC11007158 DOI: 10.3389/frph.2024.1356790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Engaging in risky sexual behaviors can lead to HIV infection, sexually transmitted infections, and unintended pregnancy among youths. University students had greater sexual risks for many reasons. Therefore, this study aimed to assess the magnitude and associated factors of risky sexual behaviors among regular undergraduate students at Injibara University, Northwest Ethiopia. Methods A cross-sectional study was conducted at Injibara University from 20 January to 30 2020. Multistage sampling was employed to select 770 students. Data were collected using a semistructured self-administered questionnaire. A binary logistic regression model was used to identify factors associated with risky sexual behavior. Adjusted odds ratios with 95% CIs were determined, and variables with P-values <0.05 were considered significant. Result A total of 770 students participated in the study, providing a response rate of 100%. In this study, 294 (38%, 95% CI: 35%, 42%) students engaged in risky sexual behaviors. Risky sexual behavior was significantly associated with not tested for HIV (AOR = 1.62, 95% CI: 1.15-2.31), peer pressure (AOR = 1.90, CI: 1.37-2.64), basic HIV knowledge (AOR = 2.16, CI: 1.65-2.89), substance use (AOR = 3.56, CI: 2.11-6.06), watching pornography videos (AOR = 1.58, CI: 1.11-2.23), and HIV risk perception (AOR = 1.37, CI: 1.02-1.91). Conclusion and recommendation A substantial proportion of university students in this study engaged in unsafe sexual behavior. Risky sexual behaviors are more likely to occur when students are under peer pressure, use substances, have no perceived HIV risk, watch pornography, and have inadequate basic HIV knowledge. Therefore, tailored strategic interventions such as life skill training should be designed to bring about positive behavioral changes among university students.
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Affiliation(s)
- Mekdes Abera Adal
- Injibara District Health Office, Awi Zone Health Department, Amhara Regional Health Bureau, Injibara, Ethiopia
| | - Saron Abeje Abiy
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mebratu Mitiku Reta
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Silamsaw Asres
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yaregal Animut
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Pattathil N, Roy A. Promising practices for the design and implementation of sexuality education programmes for youth in India: a scoping review. Sex Reprod Health Matters 2023; 31:2244268. [PMID: 37712401 PMCID: PMC10506433 DOI: 10.1080/26410397.2023.2244268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Sexual violence and HIV/AIDS are major public health concerns in India. By promoting bodily autonomy, wellbeing, and dignity through knowledge and skills, comprehensive sexuality education for young people can help prevent adverse sexual and reproductive health outcomes. While there is increased recognition globally regarding young people's need for sexuality education, translating this recognition into accepted programmes in India has been challenging. This scoping review aims to examine recommendations for promising practices for the design and implementation of sexuality education programmes and resources aimed at youth in India. A systematic search and review of the literature was conducted from June to August 2020. Of the total 5312 citations identified and screened, 622 advanced to full-text screening, and 39 were included in the final analysis. Promising practices include the need to: tailor content to serve the needs of the specific youth population being targeted; use engaging and participatory methods to teach sexual health content; work in partnership and collaboration with local experts and organisations; address potential barriers to participation and work to mitigate those barriers for marginalised youth; be youth friendly, flexible and convenient; and to be developmentally and culturally appropriate for the Indian youth context. Sexuality education programmes should integrate into existing community services and link with local reproductive health services to help provide youth with access to the services they may need. Continued work and efforts are required to address the interrelated and broad structural factors, including political, financial, social, and cultural factors that affect youth sexual health and wellbeing.
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Affiliation(s)
- Niveditha Pattathil
- Medical Student, Faculty of Health Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Amrita Roy
- Assistant Professor, Department of Family Medicine, Queen’s University, Kingston, ON, Canada
- Assistant Professor (cross-appointed), Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
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Amo-Adjei J, Yenyi A, Ahanotu B, Okyere J. Reaching young people living with HIV & AIDS and young people in detention with comprehensive sexuality education (CSE): a preparatory formative study in Ghana. Sex Reprod Health Matters 2023; 31:2235801. [PMID: 37493474 PMCID: PMC10373617 DOI: 10.1080/26410397.2023.2235801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted.
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Affiliation(s)
- Joshua Amo-Adjei
- Senior Lecturer, Department of Population and Health, University of Cape Coast, CA, Cape Coast, Ghana
| | - Adwoa Yenyi
- Programme Specialist – Adolescents and Youth, UNFPA, Accra, Ghana
| | - Brian Ahanotu
- Monitoring and Evaluation Associate, UNFPA, Accra, Ghana
| | - Joshua Okyere
- PhD Candidate, Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Armstrong-Mensah E, Ofori E, Alema-Mensah E, Agyarko-Poku T. HIV destigmatization: perspectives of people living with HIV in the Kumasi Metropolis in Ghana. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1169216. [PMID: 37799493 PMCID: PMC10548132 DOI: 10.3389/frph.2023.1169216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
Background Human immunodeficiency virus (HIV)-related stigma has been identified as one of the principal factors that undermines HIV prevention efforts and the quality of life of people living with HIV (PLWH) in many developing countries including Ghana. While studies have been conducted on HIV-related stigma reduction, very few have sought the views of PLWH on how this might be done. The purpose of the study was to (i) identify factors that cause HIV-related stigma in Ghana from the perspective of PLWH, (ii) identify challenges that HIV-related stigma poses to the treatment and care of PLWH, and (iii) to obtain recommendations from PLWH on what they think various groups (community members, health care providers, and adolescents) including themselves should do to help reduce HIV-related stigma in Ghana. Methods A mixed methods cross-sectional study design was used to collect data from 404 PLWH at the Suntreso Government Hospital in the Kumasi Metropolis of Ghana across six domains using Qualtrics from November 1-30, 2022. Quantitative data was analyzed using the Statistical Package for Social Sciences (SPSS) version 26 and the Statistical Analysis System (SAS) version 9.4. Qualitative data was analyzed using a thematic approach. Results Most of the study participants (70.5%) said HIV-related stigma in Ghana is due to ignorance. Of this population, 90.6% indicated that they had experienced stigma because they have HIV, causing them to feel depressed (2.5%), ashamed (2.2%), and hurt (3.0%). Study participants (92.8%) indicated that the challenges associated with HIV-related stigma has affected their treatment and care-seeking behaviors. Recommendations provided by study participants for HIV destigmatization include the need for PLWH not to disclose their status (cited 94 times), community members to educate themselves about HIV (96.5%), health care providers to identify their stigmatizing behaviors (95.3%), health care providers to avoid discriminating against PLWH (96.0%), and the need for adolescents to be educated on HIV and how it is transmitted (97.0%). Conclusion It is important for the government and HIV prevention agencies in Ghana to target and address co-occurring HIV-related stigma sources at various levels of intersection simultaneously This will help to shift harmful attitudes and behaviors that compromise the health and wellbeing of PLWH effectively.
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Affiliation(s)
- Elizabeth Armstrong-Mensah
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Emmanuel Ofori
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Bose DL, Hundal A, Singh S, Singh S, Seth K, Hadi SU, Saran A, Joseph J, Goyal K, Salve S. Evidence and gap map report: Social and Behavior Change Communication (SBCC) interventions for strengthening HIV prevention and research among adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs). CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1297. [PMID: 36911864 PMCID: PMC9831290 DOI: 10.1002/cl2.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Adolescent girls and young women (AGYW), aged 15-24 years, are disproportionately affected by HIV and other sexual and reproductive health (SRH) risks due to varying social, cultural, and economic factors that affect their choices and shape their knowledge, understanding, and practices with regard to their health. Socio-Behavioral Change Communication (SBCC) interventions targeted at strengthening the capabilities of individuals and their networks have supported the demand and uptake of prevention services and participation in biomedical research. However, despite growing global recognition of the domain, high-quality evidence on the effectiveness of SBCC remains scattered. This evidence and gap map (EGM) report characterizes the evidence base on SBCC interventions for strengthening HIV Prevention and Research among AGYW in low- and middle-income countries (LMICs), identifying evidence gaps and outlining the scope of future research and program design. Objectives The objectives of the proposed EGM are to: (a) identify and map existing EGMs in the use of diverse SBCC strategies to strengthen the adoption of HIV prevention measures and participation in research among AGYW in LMICs and (b) identify areas where more interventions and evidence are needed to inform the design of future SBCC strategies and programs for AGYW engagement in HIV prevention and research. Methods This EGM is based on a comprehensive search of systematic reviews and impact evaluations corresponding to a range of interventions and outcomes-aimed at engaging AGYW in HIV prevention and research - that were published in LMICs from January 2000 to April 2021. Based on guidance for producing a Campbell Collaboration EGM, the intervention and outcome framework was designed in consultation with a group of experts. These interventions were categorized across four broad intervention themes: mass-media, community-based, interpersonal, and Information Communication and Technology (ICT)/Digital Media-based interventions. They were further sub-categorized into 15 intervention categories. Included studies looked at 23 unique behavioral and health outcomes such as knowledge attitude and skills, relationship dynamics, household dynamics, health care services, and health outcomes and research engagement. The EGM is presented as a matrix in which the rows are intervention categories/sub-categories, and the columns are outcome domains/subdomains. Each cell is mapped to an intervention targeted at outcomes. Additional filters like region, country, study design, age group, funding agency, influencers, population group, publication status, study confidence, setting, and year of publication have been added. Selection Criteria To be eligible, studies must have tested the effectiveness of SBCC interventions at engaging AGYW in LMICs in HIV prevention and research. The study sample must have consisted of AGYW between the ages of 15-24, as defined by UNAIDS. Both experimental (random assignment) and quasi-experimental studies that included a comparison group were eligible. Relevant outcomes included those at the individual, influencer, and institutional levels, along with those targeting research engagement and prevention-related outcomes. Results This EGM comprises 415 impact evaluations and 43 systematic reviews. Interventions like peer-led interactions, counseling, and community dialogues were the most dominant intervention sub-types. Despite increased digital penetration use of media and technology-driven interventions are relatively less studied. Most of the interventions were delivered by peers, health care providers, and educators, largely in school-based settings, and in many cases are part of sex-education curricula. Evidence across geographies was mostly concentrated in Sub-Saharan Africa (70%). Most measured outcomes focused on disease-related knowledge dissemination and enhancing awareness of available prevention options/strategies. These included messaging around consistent condom use, limiting sexual partners, routine testing, and awareness. Very few studies were able to include psychographic, social, and contextual factors influencing AGYW health behaviors and decisions, especially those measuring the impact of social and gender norms, relationship dynamics, and household dynamics-related outcomes. Outcomes related to engagement in the research were least studied. Conclusion This EGM highlights that evidence is heavily concentrated within the awareness-intent spectrum of behavior change and gets lean for outcomes situated within the intent-action and the action-habit formation spectrum of the behavior change continuum. Most of the evidence was concentrated on increasing awareness, knowledge, and building risk perception around SRH domains, however, fewer studies focused on strengthening the agency and self-efficacy of individuals. Similarly, evidence on extrinsic factors-such as strengthening social and community norms, relationships, and household dynamics-that determine individual thought and action such as negotiation and life skills were also found to be less populated. Few studies explore the effectiveness of these interventions across diverse AGYW identities, like pregnant women and new mothers, sex workers, and people living with HIV, leading to limited understanding of the use of these interventions across multiple user segments including key influencers such as young men, partners, families, religious leaders, and community elders was relatively low. There is a need for better quality evidence that accounts for the diversity of experiences within these populations to understand what interventions work, for whom, and toward what outcome. Further, the evidence for use of digital and mass-media tools remains poorly populated. Given the increasing penetration of these tools and growing media literacy on one end, with widening gender-based gaps on the other, it is imperative to gather more high-quality evidence on their effectiveness. Timely evidence generation can help leverage these platforms appropriately and enable intervention designs that are responsive to changing communication ecologies of AGYW. SBCC can play a critical role in helping researchers meaningfully engage and collaborate with communities as equal stakeholders, however, this remains poorly evidenced and calls for investigation and investment. A full list of abbreviations and acronyms are available in Supporting Information: Appendix F.
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Mardanpour M, Rezaei J, Vaisi Raygani AA, Abdi A, Salari N, Khaledi-Paveh B, Mohammadi MM. The Effect of Family-Centered and Peer-Centered Education on the Sleep Quality of Hemodialysis Patients: A Randomized Clinical Trial. SAGE Open Nurs 2023; 9:23779608231178614. [PMID: 37273547 PMCID: PMC10233576 DOI: 10.1177/23779608231178614] [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: 02/02/2023] [Revised: 04/07/2023] [Accepted: 05/06/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Sleep disorders in hemodialysis patients are of high prevalence affecting the lives of these patients. Objective The present study was conducted to investigate the effect of family-centered and peer-centered education on the sleep quality of hemodialysis patients. Methods In this controlled clinical trial, 90 patients were randomly assigned to three groups (control, family-centered, and peer-centered). All three groups completed Pittsburgh Sleep Quality Index before the intervention. The intervention included five training sessions conducted by the researcher according to the patients' needs to improve their sleep quality. Routine ward interventions were performed for the control group. At the end of the study, the Pittsburgh Sleep Quality Index was completed by all three groups once again. Data were collected and analyzed using SPSS version 24 software and statistical tests. Results No significant difference was found between the two intervention and control groups regarding demographic variables and variables related to sleep quality before the intervention (p < .05). However, based on the results of the Wilcoxon test, there was a statistically significant difference between the mean rank of sleep quality in the intervention and control groups after the intervention (p-value = .008), indicating that sleep hygiene education was effective in the two intervention groups. Conclusion According to the findings, the mean rank of sleep quality in the two intervention groups was significant after the training, indicating the effectiveness of family-centered and peer-centered education. Accordingly, medical healthcare managers, policymakers, and planners, including nurses, are recommended to employ these convenient, safe, and cost-free training methods and provide better sleep quality and more comfort to patients by spending a short period of time for training.
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Affiliation(s)
- Maryam Mardanpour
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jahangir Rezaei
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Akbar Vaisi Raygani
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behnam Khaledi-Paveh
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Dodd S, Widnall E, Russell AE, Curtin EL, Simmonds R, Limmer M, Kidger J. School-based peer education interventions to improve health: a global systematic review of effectiveness. BMC Public Health 2022; 22:2247. [PMID: 36461024 PMCID: PMC9719233 DOI: 10.1186/s12889-022-14688-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Peer education, whereby peers ('peer educators') teach their other peers ('peer learners') about aspects of health is an approach growing in popularity across school contexts, possibly due to adolescents preferring to seek help for health-related concerns from their peers rather than adults or professionals. Peer education interventions cover a wide range of health areas but their overall effectiveness remains unclear. This review aims to summarise the effectiveness of existing peer-led health interventions implemented in schools worldwide. METHODS Five electronic databases were searched for eligible studies in October 2020. To be included, studies must have evaluated a school-based peer education intervention designed to address the health of students aged 11-18-years-old and include quantitative outcome data to examine effectiveness. The number of interventions were summarised and the impact on improved health knowledge and reductions in health problems or risk-taking behaviours were investigated for each health area separately, the Mixed Methods Appraisal Tool was used to assess quality. RESULTS A total of 2125 studies were identified after the initial search and 73 articles were included in the review. The majority of papers evaluated interventions focused on sex education/HIV prevention (n = 23), promoting healthy lifestyles (n = 17) and alcohol, smoking and substance use (n = 16). Papers mainly reported peer learner outcomes (67/73, 91.8%), with only six papers (8.2%) focussing solely on peer educator outcomes and five papers (6.8%) examining both peer learner and peer educator outcomes. Of the 67 papers reporting peer learner outcomes, 35/67 (52.2%) showed evidence of effectiveness, 8/67 (11.9%) showed mixed findings and 24/67 (35.8%) found limited or no evidence of effectiveness. Of the 11 papers reporting peer educator outcomes, 4/11 (36.4%) showed evidence of effectiveness, 2/11 (18.2%) showed mixed findings and 5/11 (45.5%) showed limited or no evidence of effectiveness. Study quality varied greatly with many studies rated as poor quality, mainly due to unrepresentative samples and incomplete data. DISCUSSION School-based peer education interventions are implemented worldwide and span a wide range of health areas. A number of interventions appear to demonstrate evidence for effectiveness, suggesting peer education may be a promising strategy for health improvement in schools. Improvement in health-related knowledge was most common with less evidence for positive health behaviour change. In order to quantitatively synthesise the evidence and make more confident conclusions, there is a need for more robust, high-quality evaluations of peer-led interventions using standardised health knowledge and behaviour measures.
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Affiliation(s)
- Steven Dodd
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Emily Widnall
- Population Health Sciences, University of Bristol, Bristol, UK.
| | | | - Esther Louise Curtin
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Mark Limmer
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, UK
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Chowdhary P, Mekuria FT, Tewahido D, Gulema H, Derni R, Edmeades J. Building sustainable and scalable peer-based programming: promising approaches from TESFA in Ethiopia. Reprod Health 2022; 19:55. [PMID: 35698076 PMCID: PMC9195188 DOI: 10.1186/s12978-021-01304-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/11/2022] Open
Abstract
Background Girls in Ethiopia’s Amhara region experience high rates of child marriage and are less able to negotiate sex or use family planning. Seeking to improve their lives, CARE’s TESFA programme delivered reproductive health and financial savings curricula to married girls via reflective dialogues in peer-based solidarity groups. From 2010 to 2013, 5,000 adolescent girls participated via three intervention arms: sexual and reproductive health, economic empowerment, and a combination of both. At end-line, participants reported improvements across health and empowerment outcomes. Four years post-TESFA, 88% of groups reported meeting without continued assistance from CARE. Some original participants had created new groups based on the TESFA model, and some girls not recruited for TESFA spontaneously replicated it to create their own groups. However, questions remained about what had contributed to this organic sustainment and scale-up of groups. Methods This 2018 study investigated factors affecting sustainability and scale-up of peer solidarity groups through a systematic mapping of TESFA groups across five woredas (districts) and interviews with key stakeholders. Data were collected from 39 focus groups with active and dissolved Girl Groups, Social Analysis and Action groups, and girls’ husbands and from 29 in-depth interviews with group facilitators and community health workers across three districts. Data were coded and analyzed per grounded theory principles. Results Changes in reproductive health knowledge and specific behaviours, such as contraceptive use and institutional delivery, were maintained 5 years after the intervention ended. Group connectedness, spousal support, integration of holistic community platforms, and opportunities for financial independence were found to be important for group sustainability. Observed changes in TESFA girls’ confidence to negotiate and assert their rights, hopes of improved mobility, and the promise of economic opportunity commonly inspired spontaneous replication of groups. Recommendations for future peer-based programmes include creating environments of solidarity and holistically engaging intervention communities. Conclusion By increasing knowledge of and access to reproductive health services, TESFA mitigates some of the harmful effects of child marriage. The maintenance and organic replication of groups suggest that TESFA provides a successful, scalable and sustainable tested model for reproductive health program delivery through peer-based solidarity groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01304-7. In Ethiopia, married girls are a particularly vulnerable adolescent population because of the many health risks associated with early marriage. Peer-based approaches are a common strategy to improve sexual and reproductive health knowledge and behaviours for marginalized groups. Critiques of these approaches are that they lack sustainability without ongoing investment and have no lasting impact on health behaviours. CARE’s TESFA programme, a peer-based approach with married adolescent girls in South Gondar, was found to be effective in creating long-term behavior change related to uptake of family planning and rates of institutional delivery. Some 88% of groups who received the TESFA curriculum were still meeting 4 years after the programme had concluded. Some participants even created groups of their own, scaling TESFA beyond the original audience, suggesting a potential approach to wider scale-up. To explore lessons learned around scale and sustainability, this study interviewed TESFA participants and stakeholders. Improvements in behaviours related to contraceptive use, institutional delivery, and girls’ agency in reproductive decision-making were sustained over time regardless of group status. Factors that affected the sustainability and scale-up of groups included solidarity among group members, support from husbands and community members, ongoing savings and loan structures, flexibility of group processes, and availability of relevant curriculum topics. Through an analysis of these findings, this paper discusses recommendations for sustainable and scalable peer-based programme design via existing Ethiopian community structures. Using TESFA principles as a model, practitioners could design and implement scalable and sustainable peer-based programming for adolescents sexual and reproductive health.
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Affiliation(s)
| | | | - Dagmawit Tewahido
- Research and Community Service, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hanna Gulema
- Global Public Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Ryan Derni
- Health Equity and Rights Team, CARE USA, Atlanta, USA
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Ayala G, Sprague L, van der Merwe LLA, Thomas RM, Chang J, Arreola S, Davis SLM, Taslim A, Mienies K, Nilo A, Mworeko L, Hikuam F, de Leon Moreno CG, Izazola-Licea JA. Peer- and community-led responses to HIV: A scoping review. PLoS One 2021; 16:e0260555. [PMID: 34852001 PMCID: PMC8635382 DOI: 10.1371/journal.pone.0260555] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/18/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In June 2021, United Nations (UN) Member States committed to ambitious targets for scaling up community-led responses by 2025 toward meeting the goals of ending the AIDS epidemic by 2030. These targets build on UN Member States 2016 commitments to ensure that 30% of HIV testing and treatment programmes are community-led by 2030. At its current pace, the world is not likely to meet these nor other global HIV targets, as evidenced by current epidemiologic trends. The COVID-19 pandemic threatens to further slow momentum made to date. The purpose of this paper is to review available evidence on the comparative advantages of community-led HIV responses that can better inform policy making towards getting the world back on track. METHODS We conducted a scoping review to gather available evidence on peer- and community-led HIV responses. Using UNAIDS' definition of 'community-led' and following PRISMA guidelines, we searched peer-reviewed literature published from January 1982 through September 2020. We limited our search to articles reporting findings from randomized controlled trials as well as from quasi-experimental, prospective, pre/post-test evaluation, and cross-sectional study designs. The overall goals of this scoping review were to gather available evidence on community-led responses and their impact on HIV outcomes, and to identify key concepts that can be used to quickly inform policy, practice, and research. FINDINGS Our initial search yielded 279 records. After screening for relevance and conducting cross-validation, 48 articles were selected. Most studies took place in the global south (n = 27) and a third (n = 17) involved youth. Sixty-five percent of articles (n = 31) described the comparative advantage of peer- and community-led direct services, e.g., prevention and education (n = 23) testing, care, and treatment programs (n = 8). We identified more than 40 beneficial outcomes linked to a range of peer- and community-led HIV activities. They include improved HIV-related knowledge, attitudes, intentions, self-efficacy, risk behaviours, risk appraisals, health literacy, adherence, and viral suppression. Ten studies reported improvements in HIV service access, quality, linkage, utilization, and retention resulting from peer- or community-led programs or initiatives. Three studies reported structural level changes, including positive influences on clinic wait times, treatment stockouts, service coverage, and exclusionary practices. CONCLUSIONS AND RECOMMENDATIONS Findings from our scoping review underscore the comparative advantage of peer- and community-led HIV responses. Specifically, the evidence from the published literature leads us to recommend, where possible, that prevention programs, especially those intended for people living with and disproportionately affected by HIV, be peer- and community-led. In addition, treatment services should strive to integrate specific peer- and community-led components informed by differentiated care models. Future research is needed and should focus on generating additional quantitative evidence on cost effectiveness and on the synergistic effects of bundling two or more peer- and community-led interventions.
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Affiliation(s)
- George Ayala
- MPact Global Action for Gay Men’s Health and Rights, Oakland, CA, United States of America
- Alameda County Department of Public Health, Oakland, CA, United States of America
- * E-mail:
| | - Laurel Sprague
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - L. Leigh-Ann van der Merwe
- Social, Health and Empowerment Feminist Collective of Transgender Women in Africa, East London, South Africa
- Innovative Response Globally to Transgender Women and HIV (IRGT), Oakland, CA, United States of America
| | | | - Judy Chang
- International Network of People Who Use Drugs, London, United Kingdom
| | - Sonya Arreola
- MPact Global Action for Gay Men’s Health and Rights, Oakland, CA, United States of America
- Arreola Research, San Francisco, CA, United States of America
| | | | | | - Keith Mienies
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | | | - Lillian Mworeko
- International Community of Women Living with HIV Eastern Africa, Kampala, Uganda
| | - Felicita Hikuam
- AIDS and Rights Alliance for Southern Africa, Windhoek, Namibia
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Kose J, Lenz C, Akuno J, Kiiru F, Jelagat Odionyi J, Otieno-Masaba R, Okoth EA, Woelk G, Leselewa S, Leendert Fraaij P, Rakhmanina N. Supporting adolescents living with HIV within boarding schools in Kenya. PLoS One 2021; 16:e0260278. [PMID: 34855779 PMCID: PMC8638902 DOI: 10.1371/journal.pone.0260278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/06/2021] [Indexed: 11/19/2022] Open
Abstract
Adolescents and youth living with HIV (AYLHIV) are a uniquely vulnerable population facing challenges around adherence, disclosure of HIV status and stigma. Providing school-based support for AYLHIV offers an opportunity to optimize their health and wellbeing. The purpose of this study was to evaluate the feasibility of school-based supportive interventions for AYLHIV in Kenya. From 2016-2019, with funding from ViiV Healthcare, the Elizabeth Glaser Pediatric AIDS Foundation implemented the innovative Red Carpet Program (RCP) for AYLHIV in participating public healthcare facilities and boarding schools in Homa Bay and Turkana Counties in Kenya. In this analysis, we report the implementation of the school-based interventions for AYLHIV in schools, which included: a) capacity building for overall in-school HIV, stigma and sexual and reproductive health education; b) HIV care and treatment support; c) bi-directional linkages with healthcare facilities; and d) psychosocial support (PSS). Overall, 561 school staff and 476 school adolescent health advocates received training to facilitate supportive environments for AYLHIV and school-wide education on HIV, stigma, and sexual and reproductive health. All 87 boarding schools inter-linked to 66 regional healthcare facilities to support care and treatment of AYLHIV. Across all RCP schools, 546 AYLHIV had their HIV status disclosed to school staff and received supportive care within schools, including treatment literacy and adherence counselling, confidential storage and access to HIV medications. School-based interventions to optimize care and treatment support for AYLHIV are feasible and contribute to advancing sexual and reproductive health within schools.
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Affiliation(s)
- Judith Kose
- Technical Strategy and Innovation, The Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
- Erasmus MC, Department of Viroscience, Erasmus University, Rotterdam, the Netherlands
| | - Cosima Lenz
- Technical Strategy and Innovation, The Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | - Job Akuno
- Country Program, The Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Fred Kiiru
- Ministry of Education, Homa Bay County, Kenya
| | | | - Rose Otieno-Masaba
- Country Program, The Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Elizabeth A. Okoth
- Country Program, The Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Godfrey Woelk
- Research Department, The Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | | | - Pieter Leendert Fraaij
- Pediatric Infectious Diseases Division, Erasmus MC-Sophia/ Erasmus University, Rotterdam, the Netherlands
| | - Natella Rakhmanina
- Technical Strategy and Innovation, The Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
- The George Washington University, Washington, DC, United States of America
- Children’s National Hospital, Washington, DC, United States of America
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Shangase N, Kharsany ABM, Ntombela NP, Pettifor A, McKinnon LR. A Systematic Review of Randomized Controlled Trials of School Based Interventions on Sexual Risk Behaviors and Sexually Transmitted Infections Among Young Adolescents in Sub-Saharan Africa. AIDS Behav 2021; 25:3669-3686. [PMID: 33772695 DOI: 10.1007/s10461-021-03242-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/29/2022]
Abstract
Young adolescents in Sub-Saharan Africa (SSA) are at high risk of involvement in sexual risk behaviors; and curable sexually transmitted infections (STI), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV) and unintended pregnancies remain persistently high in this population. Evidence based strategies are urgently needed to improve these outcomes. The aim of this systematic review was to synthesize the evidence from randomized controlled trials (RCT) to determine whether school-based interventions promote safe sex behaviors, reduce sexual risk behaviors and risk of curable STIs, HSV-2, HIV and unintended pregnancies among young adolescents aged 9-19 years in SSA. Electronic databases were searched for published studies and manual searches were conducted through reviewing of references of cited literature in the English language up to December 2019. Two independent reviewers screened and abstracted the data. We identified 428 articles and data from nine RCTs (N = 14,426 secondary school students) that fulfilled the selection criteria were analysed. Two studies measured pregnancy as an outcome and showed significant declines in unintended pregnancies. Of the five studies that measured HIV/AIDS related-knowledge, condom-use outcomes (normative beliefs, knowledge, and self-efficacy) and attitudes to HIV testing, four showed significant improvements. Of the six studies that measured sexual debut, four reported moderate but non-significant declines and in two studies sexual debut information was either incomplete or unreliable. One study measured curable STIs and found no significant declines; whilst the second study that measured HSV-2 and HIV, no significant declines were observed. This review highlights the need to undertake well-designed research studies to provide evidence on the impact of interventions on curable STIs, HSV-2 and HIV, critical to improving the health of young adolescents.
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Affiliation(s)
- Nosipho Shangase
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 2106 McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599-7435, USA
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.
- School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Nonzwakazi P Ntombela
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Audrey Pettifor
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Lyle R McKinnon
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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Hosaka KRJ, Mmbaga BT, Gallis JA, Dow DE. Feasibility and acceptability of a peer youth led curriculum to improve HIV knowledge in Northern Tanzania: resilience and intervention experience from the perspective of peer leaders. BMC Public Health 2021; 21:1925. [PMID: 34688254 PMCID: PMC8542314 DOI: 10.1186/s12889-021-11876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Youth Living with HIV (YLWH) have reduced adherence to antiretroviral therapy (ART) and worse virologic outcomes compared to children and adults. HIV peer youth led (PYL) interventions contribute to improved retention in care and psychosocial wellbeing. The study objective was to assess the feasibility and acceptability of a PYL HIV curriculum and describe change in participants' knowledge and impact of leadership on peer leaders' lives. METHODS An HIV curriculum was taught during monthly Saturday adolescent HIV clinics at two clinical sites in Moshi, Tanzania (2018-2019). Youth attending clinics were ages 12 to 24 years and received the HIV curriculum during routine clinical care. Peer leaders previously participated in a mental health and life skills intervention called Sauti ya Vijana (The Voice of Youth; SYV) and were recommended for leadership by SYV facilitators and clinic staff. Peer leaders were trained and supervised weekly in curriculum delivery using a "train the trainer" model. Data were collected and analyzed using mixed methods. Fidelity checklists were used to measure adherence to the curriculum. Youth participants answered written pre- and post-knowledge questions and evaluated PYL teaching. Semi-structured interviews and the Connor Davidson Resilience scale were conducted with peer leaders before and after assuming the leadership role. RESULTS Peer leaders (N = 4 male; 3 female) demonstrated high fidelity (96%) to activities in each lesson and participant feedback was positive for curriculum delivery. Participants' knowledge improved in nine of ten sessions. All but one leader-who moved away before the study ended-demonstrated stable or improved resilience with a mean difference of 3.8 (SD = 7.0) from before the intervention to after assuming the leadership role. Peer leaders reported improved leadership confidence and resilience, and their perception was that the curriculum helped normalize the HIV experience for YLWH attending clinic. Nevertheless, anticipated stigma, difficulty disclosing HIV status, and teaching ability remained barriers. CONCLUSIONS This study demonstrated that a PYL curriculum to improve HIV knowledge integrated into routine adolescent HIV clinic in Tanzania was feasible, acceptable, and improved knowledge while also benefiting peer leaders, thus providing evidence to continue to support efforts to scale and sustain PYL interventions for YLWH.
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Affiliation(s)
- Kalei R J Hosaka
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
| | - John A Gallis
- Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Dorothy E Dow
- Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
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A cross-country qualitative study on contraceptive method mix: contraceptive decisionmaking among youth. Reprod Health 2021; 18:105. [PMID: 34034757 PMCID: PMC8145785 DOI: 10.1186/s12978-021-01160-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Youth ages 15 to 24, who comprise a large portion of sub-Saharan Africa, face a higher burden of unmet contraceptive need than adults. Despite increased international and national commitments to improving young people’s access to contraception, significant barriers impede their access to a full range of methods. To further explore these barriers among youth in Kenya, Nigeria, and Uganda, we conducted a qualitative study to capture the challenges that affect contraceptive method decisionmaking and complicate youth access to the full method mix. Methods To understand factors that impact young people’s contraceptive decisionmaking process across all three countries, we conducted a total of 35 focus group discussions with 171 youth ages 15 to 24 and 130 in-depth interviews with key stakeholders working in youth family planning. Questionnaires aligned with the High Impact Practices in Family Planning’s elements of adolescent-friendly contraceptive services. Data were coded with MAXQDA and analyzed using a framework for contraceptive decisionmaking to identify relevant patterns and themes. Results In all three countries, youth reported that condoms are the most commonly sought contraceptive method because they are easiest to access and because youth have limited knowledge of other methods. Youth from diverse settings shared uncertainty and concern about the safety and side effects of many methods other than condoms, complicating their ability to take full advantage of other available methods. While most youth in Kenya, Nigeria, and Uganda reported at least moderate confidence in obtaining the information needed to help choose a method, and only a few youth reported that they are completely unable to access contraceptives, other barriers still present a major deterrent for youth, including cost, inconvenient facility hours and long wait times, and stigma from family, community members, and providers. Conclusions Young people’s ability to fully exercise their method choice remains limited despite availability of services, leading them to take the path of least resistance. Program implementers and policymakers should consider the diverse and often interconnected barriers that youth face in attempting to enjoy the benefits of a full spectrum of contraceptive methods and design multi-level interventions to mitigate such barriers. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01160-5. Despite increased international and national commitments to improving young people’s access to contraception, youth ages 15 to 24 face significant barriers to accessing a full range of contraceptive methods. This study conducted in-depth interviews with key stakeholders and focus group discussions with youth in Kenya, Nigeria, and Uganda to understand what factors impact youth’s decision to use or not use certain contraceptive methods. In all three countries, youth reported that condoms are the most commonly sought contraceptive method because they are easiest to access and because youth have limited knowledge of other methods. Youth from diverse settings shared uncertainty and concern about the safety and side effects of many methods other than condoms. While most youth in Kenya, Nigeria, and Uganda reported at least moderate confidence in obtaining the information needed to help choose a method, other barriers like cost, inconvenient facility hours and long wait times, and stigma from family, community members, and providers still present a major deterrent for youth who want information on contraceptive methods. Program implementers and policymakers should consider the diverse and often interconnected barriers that youth face in attempting to enjoy the benefits of a full spectrum of contraceptive methods and design multi-level interventions to mitigate such barriers.
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15
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Ceylan E, Koç A. Effect of peer education model on nursing students' knowledge and attitudes towards HIV/AIDS. NURSE EDUCATION TODAY 2021; 99:104808. [PMID: 33610052 DOI: 10.1016/j.nedt.2021.104808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/22/2020] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This research is an intervention study designed as a single group pre-test post-test model without control group in order to examine the effect of education provided to nursing students based on peer education model on HIV/AIDS knowledge level and attitude. DESIGN, METHODS, SETTINGS AND PARTICIPANTS The research was carried out at Nursing Department of Ankara Yıldırım Beyazıt University. Sample of the study consisted of second year nursing students who agreed to participate in the study and enrolled Internal Medicine Nursing course for the first time (n = 88). In the first stage of the study, nine peer mentors were selected and a total of 12 h of training were given to them by the researchers. In the second stage, peer mentors provided a total of 12 h of training to nine peer students groups. All groups were created by simple randomization on the "research randomizer" website. Demographics questionnaire, AIDS knowledge scale and AIDS attitude scale were used to collect the data. Data was analyzed by using descriptive statistics, Pearson Chi-square test, paired sample t-Test, Wilcoxon test and Spearman correlation test. RESULTS It was determined that peer education provided a statistically significant increase in AIDS knowledge scale score in peer students (pretest x¯=10.32 ± 3.59, posttest x¯=19.69 ± 1.51) (p < 0.001). In addition, peer education was found to provide a statistically significant increase in AIDS attitude scale score in peer students (pretest x¯=56.64 ± 8.36, posttest x¯=72.95 ± 7.02) (p < 0.001). CONCLUSION It has been determined that peer education method is an effective method in increasing HIV/AIDS knowledge and attitude towards people living with HIV/AIDS in nursing students. Therefore, it is recommended to include peer education model in nursing educations regarding HIV/AIDS.
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Affiliation(s)
- Erdal Ceylan
- Ankara Yıldırım Beyazıt University, Faculty of Health Sciences, Nursing Department, Ankara, Turkey.
| | - Ayşegül Koç
- Ankara Yıldırım Beyazıt University, Faculty of Health Sciences, Nursing Department, Ankara, Turkey
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16
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Asuquo SE, Tahlil KM, Muessig KE, Conserve DF, Igbokwe MA, Chima KP, Nwanunu EC, Elijah LP, Day S, Rosenberg NE, Ong JJ, Nkengasong S, Tang W, Obiezu‐Umeh C, Nwaozuru U, Merino Y, Gbaja‐Biamila T, Oladele D, Iwelunmor J, Ezechi O, Tucker JD. Youth engagement in HIV prevention intervention research in sub-Saharan Africa: a scoping review. J Int AIDS Soc 2021; 24:e25666. [PMID: 33569913 PMCID: PMC7876473 DOI: 10.1002/jia2.25666] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/20/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Youth engagement in HIV research is generally recognized as essential, but often neglected or minimally implemented in practice. Engagement is a process of working collaboratively with diverse groups of people to address common issues. We conducted a scoping review of youth HIV prevention interventions in sub-Saharan Africa to identify and categorize forms and levels of youth engagement across the lifespan of intervention research. METHODS We followed Arksey and O'Malley's framework for organizing a scoping review. We searched seven databases for related articles on identified intervention studies through May 28th 2020. Included studies focused on youth (10 to 24 years old) HIV prevention interventions in sub-Saharan Africa. Two reviewers independently examined citations and full manuscripts for inclusion. Data were extracted on study characteristics, location, description of youth engagement and extent of engagement. Youth engagement approaches were categorized based on Hart's ladder as substantial engagement (strong youth decision-making power), moderate engagement (shared decision making with adults), minimal engagement (no youth decision-making power) or no engagement. RESULTS We identified 3149 citations and included 112 studies reporting on 74 unique HIV interventions. Twenty-two interventions were in low-income countries, 49 in middle-income countries, and three were in both. Overall, only nine interventions (12%) had substantial or moderate youth engagement, two-thirds (48, 65%) had minimal youth engagement and 17 interventions (23%) had no youth engagement. We also identified specific engagement strategies (e.g. youth-led research, crowdsourcing) that were feasible in multiple settings and resulted in substantial engagement. CONCLUSIONS We found limited youth engagement in youth HIV prevention intervention studies in sub-Saharan Africa. However, several activities resulted in substantial youth engagement and could be relevant in many low-and-middle-income-country (LMIC) settings.
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Affiliation(s)
- Sarah E Asuquo
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kadija M Tahlil
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kathryn E Muessig
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Donaldson F Conserve
- Department of Health Promotion, Education, and BehaviorArnold School of Public HealthUniversity of South CarolinaColumbiaSCUSA
| | - Mesoma A Igbokwe
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineUniversity of NigeriaNsukkaNigeria
| | - Kelechi P Chima
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineUniversity of NigeriaNsukkaNigeria
| | - Ezienyi C Nwanunu
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- Department of BiochemistryMichael Okpara University of AgricultureUmudikeNigeria
| | - Lana P Elijah
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineLagos State UniversityLagosNigeria
| | - Suzanne Day
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Nora E Rosenberg
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
- University of North Carolina Project MalawiLilongweMalawi
| | - Jason J Ong
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
- Central Clinical SchoolMonash UniversityMelbourneVic.Australia
| | - Susan Nkengasong
- Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineLondonUK
| | - Weiming Tang
- Dermatology HospitalSouthern Medical UniversityGuangzhouChina
| | - Chisom Obiezu‐Umeh
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Yesenia Merino
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - David Oladele
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Oliver Ezechi
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
| | - Joseph D Tucker
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
- Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
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Nolan C, Packel L, Hope R, Levine J, Baringer L, Gatare E, Umubyeyi A, Sayinzoga F, Mugisha M, Turatsinze J, Naganza A, Idelson L, Bertozzi S, McCoy S. Design and impact evaluation of a digital reproductive health program in Rwanda using a cluster randomized design: study protocol. BMC Public Health 2020; 20:1701. [PMID: 33187485 PMCID: PMC7662730 DOI: 10.1186/s12889-020-09746-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Rwandan adolescents have limited access to high-quality family planning and reproductive health (FP/RH) information and care to prevent unplanned pregnancy and HIV/STIs. In addition to the immediate implications for health and well-being, teenage pregnancy is a significant cause of school drop-out, limiting girls’ future potential and employment opportunities. This study introduces a direct-to-consumer digital education program that uses storytelling to deliver age-appropriate FP/RH information and economic empowerment training to adolescents. It also facilitates access to high-quality, youth-friendly FP/RH care and products. We evaluate two different school-based models of its implementation to understand how to optimize the uptake of contraception and HIV testing among adolescents. Methods The study consists of two distinct phases. The first formative intervention design phase, conducted from 2016 to 2019, used a human-centered design methodology to develop the intervention alongside over 600 Rwandan adolescents, their parents, teachers, and healthcare providers. Through this methodology, we sought to maximize the fit between evidence-based practices (uptake of modern contraception and HIV testing) and the implementation context of adolescents in Rwanda. The second phase is an impact evaluation, in which we will use a Hybrid Trial Type 2 Effectiveness-Implementation study design to determine the overall effectiveness of this digital intervention as well as the relative effectiveness of the two different school-based implementation models. This takes the form of a 3-arm cluster-randomized non-inferiority trial, with a sample of 6000 youth aged 12–19 in 60 schools across 8 districts in Rwanda. Primary outcome measures include use of modern contraception, delayed initiation of childbearing, and uptake of HIV testing. Discussion This study will yield insights into not only whether this digital intervention is successful in achieving the intended sexual and reproductive health outcomes, but also which mechanisms are likely to drive this effectiveness. The methodologies used are broadly applicable to the design, implementation, and evaluation of other behavior-based health programs in low and middle-income countries. Trial registration ClinicalTrials.gov Identifier: NCT04198272. Prospectively registered 13 December 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09746-7.
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Affiliation(s)
- Cara Nolan
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, MC 7360, Berkeley, CA, 94720, USA.
| | - Laura Packel
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, MC 7360, Berkeley, CA, 94720, USA
| | - Rebecca Hope
- YLabs, 2nd Floor, Golden Plaza, KG 546 St. Kacyiru, Kigali, Rwanda
| | - Jordan Levine
- YLabs, 2nd Floor, Golden Plaza, KG 546 St. Kacyiru, Kigali, Rwanda
| | - Laura Baringer
- YLabs, 2nd Floor, Golden Plaza, KG 546 St. Kacyiru, Kigali, Rwanda
| | - Emmyson Gatare
- YLabs, 2nd Floor, Golden Plaza, KG 546 St. Kacyiru, Kigali, Rwanda
| | - Aline Umubyeyi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, P.O. Box: 5229, Kigali, Rwanda
| | - Felix Sayinzoga
- Rwanda Biomedical Center, KG 17 Ave, towards Amahoro Stadium, Remera, Rukiri II, Remera, Gasabo, Kigali, Rwanda
| | - Michael Mugisha
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, P.O. Box: 5229, Kigali, Rwanda
| | - Janepher Turatsinze
- Society for Family Health, Rwanda, Plot 99 KG543 St. Kacyiru, PO Box: 3040, Kigali, Rwanda
| | - Aimee Naganza
- Society for Family Health, Rwanda, Plot 99 KG543 St. Kacyiru, PO Box: 3040, Kigali, Rwanda
| | - Laiah Idelson
- YTH Initiative, ETR, 1630 San Pablo Avenue, Suite 500, Oakland, CA, 94612, USA
| | - Stefano Bertozzi
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, MC 7360, Berkeley, CA, 94720, USA
| | - Sandra McCoy
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, MC 7360, Berkeley, CA, 94720, USA
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Nkurunziza A, Van Endert N, Bagirisano J, Hitayezu JB, Dewaele S, Tengera O, Jans G. Breaking barriers in the prevention of adolescent pregnancies for in-school children in Kirehe district (Rwanda): a mixed-method study for the development of a peer education program on sexual and reproductive health. Reprod Health 2020; 17:137. [PMID: 32894150 PMCID: PMC7487597 DOI: 10.1186/s12978-020-00986-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a variety of mainly school-driven prevention strategies, the number of adolescent pregnancies in Rwanda is worryingly high and is even expected to increase. The aim of this study is to empower Kirehe secondary school students aged 15-19 years old in sexual and reproductive health (SRH) by developing a peer education program. METHODS A combination of quantitative and qualitative research will be used. A pre- and post-survey will examine adolescents' knowledge and attitudes regarding SRH. In addition, six focus group interviews will explore these knowledge, attitudes but also SRH needs more in depth. Based on the obtained information, and after retrieving experts' input, a peer education program is being developed in which Midwifery students obtain training in SRH and educational skills (= first train-the-trainer module). In turn, these students will educate and train a selected group of secondary school students (= second train the trainer module). Finally, these trained in-school students can act as reliable peers for other in-school students in the context of SRH. DISCUSSION The project will contribute to 1) more independent and thoughtful decisions in contraception and sexual behavior, and consequently less adolescent pregnancies, and 2) the reinforcement of the Rwandan Midwifery education. TRIAL REGISTRATION University of Rwanda, College of Medicine and Health Sciences, Institutional Review Board, Approval No 158/CMHS IRB/2019.
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Affiliation(s)
- Aimable Nkurunziza
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Arthur Labatt School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Nadja Van Endert
- University Colleges Leuven-Limburg, Research & Expertise, Resilient People, Wetenschapspark 21, 3590, Diepenbeek, Belgium.,University Colleges Leuven-Limburg, Department of Health, Midwifery program, Campus LiZa, Schiepse Bos 3, 3600, Genk, Belgium
| | - Justine Bagirisano
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Bosco Hitayezu
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Sylvie Dewaele
- University Colleges Leuven-Limburg, Research & Expertise, Resilient People, Wetenschapspark 21, 3590, Diepenbeek, Belgium.,University Colleges Leuven-Limburg, Department of Health, Midwifery program, Campus LiZa, Schiepse Bos 3, 3600, Genk, Belgium
| | - Olive Tengera
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Goele Jans
- University Colleges Leuven-Limburg, Research & Expertise, Resilient People, Wetenschapspark 21, 3590, Diepenbeek, Belgium. .,University Colleges Leuven-Limburg, Department of Health, Midwifery program, Campus LiZa, Schiepse Bos 3, 3600, Genk, Belgium.
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19
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Mekonnen Munea A, Alene GD, Debelew GT. <p>Does Youth-Friendly Service Intervention Reduce Risky Sexual Behavior in Unmarried Adolescents? A Comparative Study in West Gojjam Zone, Northwest Ethiopia</p>. Healthc Policy 2020; 13:941-954. [PMID: 32801968 PMCID: PMC7402857 DOI: 10.2147/rmhp.s254685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Alemtsehay Mekonnen Munea
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
- Correspondence: Alemtsehay Mekonnen Munea Email
| | - Getu Degu Alene
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
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20
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The impact of training of peer educator on sexual and reproductive health: An interventional study. MARMARA MEDICAL JOURNAL 2020. [DOI: 10.5472/marumj.738403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Kemigisha E, Bruce K, Ivanova O, Leye E, Coene G, Ruzaaza GN, Ninsiima AB, Mlahagwa W, Nyakato VN, Michielsen K. Evaluation of a school based comprehensive sexuality education program among very young adolescents in rural Uganda. BMC Public Health 2019; 19:1393. [PMID: 31660918 PMCID: PMC6819440 DOI: 10.1186/s12889-019-7805-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Limited research has been conducted on the effectiveness of sexuality education for very young adolescents (VYAs) ages 10–14 years in Sub-Saharan Africa. Furthermore, evaluations of sexuality education programs often report outcomes of risky sexual practices, yet positive aspects of sexuality are hardly studied and rarely reported. This study evaluates the effectiveness of a Comprehensive Sexuality Education (CSE) intervention for VYAs in Uganda, analyzing both positive and negative outcome indicators. Methods We conducted a mixed methods study, incorporating a cluster randomized trial (NCT03669913) among pupils in 33 randomly selected primary schools in Mbarara district. This was followed by a qualitative evaluation of the intervention in 4 schools that included 14 in-depth interviews and 3 focus group discussions distributed among pupils, teachers and parents. Quantitative data were analyzed using ordered logistic regression to compare differences in the change from baseline to endline between the intervention and control arms. We conducted bivariate analysis and multiple regression analysis controlling for key covariates, including age, gender, school location (rural vs urban), truancy, and orphanhood. Qualitative data were analyzed by thematic approach using ATLAS TI. Results Between July 2016 and August 2017, 1096 pupils were recruited. Outcomes were studied among 380 pupils in the intervention arm and 484 pupils in the control arm. The proportion of pupils who ever had sex increased from 9 to 12.1% in intervention compared to 5.2 to 7.4% in the control group between baseline and endline, however the differences between groups were not statistically significant. We found greater improvements in sexual and reproductive health (SRH) knowledge among intervention schools (AOR: 2.18, 95% CI: 1.66–2.86) and no significant differences in self-esteem, body image or gender equitable norms. Qualitative evidence echoes perceived SRH knowledge acquisition, increased their perception of SRH related risks, and intentions to delay sexual intercourse to prevent unwanted pregnancy, HIV and other STIs. Conclusion This study demonstrates that CSE can improve SRH knowledge and behavioral intentions among VYAs in Uganda. These results further emphasize the importance of initiating sexuality education before most adolescents have started engaging in sexual activity, enabling them to make informed decisions in the future. Trial registration NCT03669913, registered retrospectively on September 13th, 2018.
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Affiliation(s)
- Elizabeth Kemigisha
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda. .,International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Katharine Bruce
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802, Munich, Germany
| | - Els Leye
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Centre of Expertise on Gender, Diversity and Intersectionality, Vrije universiteit Brussels, Brussels, Belgium
| | - Gily Coene
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije universiteit Brussels, Brussels, Belgium
| | - Gad N Ruzaaza
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Anna B Ninsiima
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije universiteit Brussels, Brussels, Belgium
| | - Wendo Mlahagwa
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Viola N Nyakato
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Kristien Michielsen
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Mahat G, Scoloveno MA. Effectiveness of Adolescent Peer Education Programs on Reducing HIV/STI Risk: An Integrated Review. Res Theory Nurs Pract 2019; 32:168-198. [PMID: 29792255 DOI: 10.1891/1541-6577.32.2.168] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is empirical evidence suggesting that peer education is efficacious in changing adolescent sexual risk behaviors; however, it is unclear if there are similarities in outcomes across studies. Thus, the purpose of this review was to synthesize published research on peer-led HIV/STI intervention programs for adolescents in an effort to determine the efficacy of peer education on knowledge, attitudes, normative beliefs, and sexual behavior. Data collection included online searches of published research from Index Medicus (Medline), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Educational Index, and PsycINFO (including PsycARTICLES) from 2000 to 2016. Twenty-four quantitative and six qualitative studies were included in the review. There appears to be evidence of the effectiveness of adolescent peer-led HIV education programs on knowledge, attitudes, normative beliefs, and self-efficacy. However, the studies reviewed were equivocal on changes in sexual behavior. The findings of the qualitative/process studies demonstrated perceived program efficacy among staff and peer educators. Peer educators and students placed a high value on peer-led programs. Mediators and/or covariates such as culture, gender, sexual experience, and age may impact findings of adolescent peer intervention studies; therefore, these factors need to be considered when implementing and evaluating peer education programs. Peer education should also focus on variables that were gleaned from qualitative studies, such as the role of the community and altruistic roles.
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23
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Than PQT, Tran BX, Nguyen CT, Truong NT, Thai TPT, Latkin CA, Ho CSH, Ho RCM. Stigma against patients with HIV/AIDS in the rapid expansion of antiretroviral treatment in large drug injection-driven HIV epidemics of Vietnam. Harm Reduct J 2019; 16:6. [PMID: 30654814 PMCID: PMC6337792 DOI: 10.1186/s12954-019-0277-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 01/04/2019] [Indexed: 02/01/2023] Open
Abstract
Background Despite existing efforts to provide antiretroviral treatment (ART) for all HIV-diagnosed people, stigma deprives them of the highest attainable health status and challenges the effectiveness of ART program in Vietnam. This study aimed to assess five dimensions of HIV-related stigma and explore its associated factors among ART patients in a multisite survey. Implications of this study support the development of HIV policies to improve patients’ access, utilization, and outcomes of ART program toward the 90-90-90 goal in Vietnam. Methods A total of 1133 ART patients who were recruited by convenience sampling method from 8 ART clinics in Hanoi and Nam Dinh in a cross-sectional study from January to August 2013. Multivariate logistic regression was employed to identify factors associated with stigmatization. Results The majority of participants reported experiencing stigmatization due to shame (36.9%), blame/judge (21.6%), and discrimination (23.4%). Further, 91.5% of participants disclosed their HIV status with others. The likelihood of experiencing stigmatization did not only associate with the patients’ socioeconomic status (e.g., age, occupation, education) and HIV status disclosure, but also their health problems. Those with anxiety or depression and perceived lower quality of life were more likely to experience stigma. Conclusions To maximize the efficiency of the ART program, it is essential to develop interventions that reduce stigma involving individuals, families, and communities, and recognize and address complex health problems especially those patients showing depressive symptoms. Increasing quality of life of HIV-positive patients by providing vocational training, financial, family, and peer support will reduce the likelihood of experiencing stigma.
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Affiliation(s)
- Phung Quoc Tat Than
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam.
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
| | - Nu Thi Truong
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Thao Phuong Thi Thai
- Department of General Planning and Department of Cardiology, Friendship Hospital, Hanoi, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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24
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Faust L, Yaya S. The effect of HIV educational interventions on HIV-related knowledge, condom use, and HIV incidence in sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health 2018; 18:1254. [PMID: 30424761 PMCID: PMC6234686 DOI: 10.1186/s12889-018-6178-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/01/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND As high stigmatization of HIV and relatively low knowledge of HIV transmission and prevention measures persist in Sub-Saharan Africa, the improvement of HIV-related knowledge, and the evaluation of which types of interventions are most effective in this regard, is an important aspect of further prevention efforts. In addition, it is of interest to assess whether improvements in HIV-related knowledge may actually lead to increased engagement in preventive behaviours and ultimately lower HIV transmission. This study therefore aims to systematically review and meta-analyse the evidence for the effect of HIV-related knowledge interventions on 1) the improvement of HIV-related knowledge, 2) subsequent risk reduction behaviour (condom use), 3) lower incidence of HIV infection. METHODS A literature search was conducted using the Embase and Medline databases, returning 746 after duplicate removal. Following abstract and full-text screening, 36 studies were ultimately included in the final review. Meta-analyses were conducted in R, using random-effects models, for the HIV-related knowledge, condom use, and HIV incidence outcomes, where sufficient data were available. RESULTS Interventions assessed in the reviewed studies varied, including computer-based interventions, mass media campaigns, and peer education interventions. The interventions were generally found to be effective at improving HIV-related knowledge in the target population, with 10 studies reporting improved knowledge of risk reduction through condom use in the intervention group (out of 11 studies reporting data for this outcome), with 6 reporting these differences as significant (p < 0.05). Regarding knowledge of transmission routes, studies assessing peer education interventions often reported significant improvements in the intervention group. Meta-analysis results showed significantly higher odds among the intervention groups of correct knowledge of: risk reduction through condom use (OR: 3.09, 95%CI: 1.83-5.22, p < 0.0001), sexual transmission of HIV (OR: 5.86, 95%CI: 2.65-12.97, p < 0.001) and transmission through sharps (OR: 4.35, 95%CI = 3.21-5.90, p < 0.001), but non-significantly lower odds of HIV infection (OR: 0.97, 95%CI: 0.66-1.41, p = 0.854). CONCLUSION Peer-education-based interventions appear to be particularly effective in facilitating the uptake of HIV-related knowledge, particularly pertaining to transmission routes. There is some evidence that improved knowledge of HIV transmission and prevention facilitates increased subsequent engagement in preventive measures, although this requires further exploration. TRIAL REGISTRATION PROSPERO Number: CRD42018090600.
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Affiliation(s)
- Lena Faust
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University, Ottawa, ON K1N 6N5 Canada
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25
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Effectiveness of a peer-led HIV/AIDS education program on HIV-related health literacy of jailed adolescents in Tunis, Tunisia. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-018-0975-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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26
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Omotehinwa OJ, Japheths O, Damascene IJ, Habtu M. Shisha use among students in a private university in Kigali city, Rwanda: prevalence and associated factors. BMC Public Health 2018; 18:713. [PMID: 29884163 PMCID: PMC5994055 DOI: 10.1186/s12889-018-5596-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND All over the globe shisha smoking is fast growing among different age brackets. Shisha use has been reported to be increasing among youths in African major cities. Its use is documented to result in health effects such as lung cancer, cardiovascular and respiratory conditions, periodontal diseases, keratoacanthoma which are also associated with cigarette smoking. In Kigali, Rwanda's capital, reports indicate that shisha use is increasing among the youths, particularly the university students. The study aimed at determining the prevalence, and establishing factors associated with shisha use among students in a university in Kigali Rwanda, which will be a significant step in stemming shisha fame among youths in Rwanda as there was no previously documented evidence-based study. METHODS A total of 427 students were selected for this cross-sectional study using stratified sampling method. A questionnaire was used to collect data on shisha use, knowledge about shisha, attitude towards shisha, and factors associated with use of shisha. The association between the independent variables and shisha use was assessed using chi-square p value < 0.05. Binary logistic regression was used to determine variables that were independently associated with shisha smoking. RESULTS Prevalence of ever smoking shisha among the university students was 26.1% and that of those that smoked in the last month (30 days) was 20.8%. About 40 % (39.9%) of the participants that had heard about shisha before demonstrated low level of knowledge, and 41.6% of these reported shisha use in the last 30 days. Logistic regression revealed that the followings were independently associated with shisha smoking: always drink alcohol (p = 0.003); drink alcohol occasionally (p = 0.045); having friend(s) who smoke shisha (p = 0.001); being aware of shisha's availability in cafes, bars and restaurants in Kigali (p = 0.022); positive attitude towards shisha smoking (p < 0.001) and participants with age < 20 years (p = 0.039). CONCLUSIONS There is a relative high prevalence of shisha smoking and a poor knowledge about its impact on health among these university students. Regular medical education and health promotion targeting the youths could improve knowledge and practices about shisha use. Shisha laws and regulations should be enacted, and fines imposed on individuals or group who flout them.
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Affiliation(s)
- Omoboriowo Joad Omotehinwa
- Department of Public Health, Mount Kenya University, School of Health Sciences, P. O. Box 5826, Kigali Campus, Kigali, Rwanda
| | - Ogendi Japheths
- Department of Public Health, Mount Kenya University, School of Health Sciences, P. O. Box 5826, Kigali Campus, Kigali, Rwanda
| | | | - Michael Habtu
- Department of Public Health, Mount Kenya University, School of Health Sciences, P. O. Box 5826, Kigali Campus, Kigali, Rwanda
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27
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Icard LD, Jemmott JB, Carty C, O'Leary A, Sidloyi L, Hsu J, Tyler J, Martinez O. Retention of South African Adolescents in a 54-Month Longitudinal HIV Risk Reduction Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 18:534-540. [PMID: 28508155 DOI: 10.1007/s11121-017-0793-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Retention of participants in clinical trials is a central concern of HIV/STI behavioral researchers and research sponsors. This article describes the strategies used for addressing the challenges in retaining South African adolescents for a 54-month longitudinal study. The objective of the South African adolescent health promotion long-term follow-up trial was to test the sustainability of the effects of an HIV/STI risk reduction intervention, "Let Us Protect Our Future," on young adolescents as they aged into middle and late adolescence. Inaccurate contact information, invalid mobile telephone numbers, lack of transportation, transitory family addresses, and family relocation were among the challenges to retaining participants. Despite a significant gap in time of 36 months between the main trial and the long-term follow-up study, 99.2% of 1057 participants were retained. Solutions used for retaining the adolescents are discussed with suggestions offered for retaining adolescents in longitudinal HIV/STI prevention clinical trials in low resource countries.
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Affiliation(s)
- Larry D Icard
- College of Public Health, School of Social Work, Temple University, Philadelphia, PA, 19122, USA.
| | - John B Jemmott
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Craig Carty
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Ann O'Leary
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lulama Sidloyi
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Hsu
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - JoAnn Tyler
- Department of Statistics, University of Fort Hare, Alice, South Africa
| | - Omar Martinez
- College of Public Health, School of Social Work, Temple University, Philadelphia, PA, 19122, USA
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Doornekamp L, Stegers-Jager KM, Vlek OM, Klop T, Goeijenbier M, van Gorp ECM. Experience with a Multinational, Secondary School Education Module with a Focus on Prevention of Virus Infections. Am J Trop Med Hyg 2017; 97:97-108. [PMID: 28719318 PMCID: PMC5508890 DOI: 10.4269/ajtmh.16-0661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Worldwide, virus infections are responsible for many diseases in terms of morbidity and mortality. Vaccinations and therapies are only available for relatively few virus infections and not always where they are needed. However, knowledge of transmission routes can prevent virus infection. In the context of this study, we measured the effects of a secondary school education module, named Viruskenner, on knowledge, attitude, and risk behavior as these relate to virus infections. A nonrandomized intervention study was conducted between April and August 2015 to assess the effect of this 2-month education module on knowledge, attitude, and behavior of 684 secondary school students in the Netherlands, Suriname, and Indonesia. For the Netherlands, a control group of a further 184 students was added. Factor analysis was performed on questions pertaining to attitude and behavior. Comparative analyses between pre- and posttest per country were done using multiple linear regression, independent sample T-tests, and one-way analysis of variance. These showed a significant increase in knowledge about virus infections and the prevention of infectious diseases among the Dutch and Surinamese groups, whereas a trend of increased knowledge was evident among the Indonesian participants. The Dutch control group showed an overall decrease in knowledge. Regression analyses showed that there was a significant interaction effect between participation and time on knowledge, attitude, and awareness and behavior and risk infection. Attitudes improved significantly in the intervention group. Pearson correlation coefficients between knowledge, attitude, and behavior were found to be positive.
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Affiliation(s)
- Laura Doornekamp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Karen M Stegers-Jager
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Tanja Klop
- Science Center Delft, University of Technology Delft, Delft, The Netherlands
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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29
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Effectiveness of an Integrated Community- and Clinic-Based Intervention on HIV Testing, HIV Knowledge, and Sexual Risk Behavior of Young Men Who Have Sex With Men in Myanmar. J Adolesc Health 2017; 60:S45-S53. [PMID: 28109340 DOI: 10.1016/j.jadohealth.2016.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE Young men who have sex with men (YMSM) in Myanmar are disproportionately affected by HIV, with prevalence five times that of the general population. The Link Up project implemented an intervention using peer education and outreach providing education and counseling on health seeking around sexually transmitted infections and reproductive health, combined with focused clinic capacity building to improve the sexual and reproductive health of YMSM. This study aimed to evaluate the effectiveness and acceptability of the intervention. METHODS Using a mixed-methods approach, and employing a quasi-experimental design, we conducted two quantitative repeat cross-sectional surveys in purposively selected control (no intervention) and intervention townships, before and after implementation of the Link Up intervention. Respondent-driven sampling was used to recruit YMSM aged 15-24 years, and study participants were administered a structured questionnaire assessing intervention exposure, health service access, knowledge of HIV, and sexual risk behavior. Focus group discussions were held to elicit perspectives on the use and acceptability of the health services and peer outreach. RESULTS At baseline, 314 YMSM were recruited in the intervention townships and 309 YMSM in the control townships. At end line, 267 (intervention) and 318 (control) YMSM were recruited. Coverage of the program was relatively low, with one-third of participants in the intervention townships having heard of the Link Up program by the end line. Comparing changes between baseline and end line, a greater proportion of HIV-negative or unknown status YMSM accessed HIV testing in the past 3 months in intervention townships (from 45.0% to 57.1%) compared with those in control townships (remained at 29.0%); however, this difference in the effect over time was not statistically significant in multivariate modeling (adjusted odds ratio: 1.45; 95% confidence interval: .66-3.17). Qualitative findings showed that the intervention was acceptable to YMSM. CONCLUSIONS Overall, the intervention was perceived as acceptable. Although not statistically significant, results showed some trends toward improvements among YMSM in accessing HIV testing services and HIV-related knowledge. The modest coverage and short time frame of the evaluation likely limits the ability for any significant behavioral improvements.
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30
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Sani AS, Abraham C, Denford S, Ball S. School-based sexual health education interventions to prevent STI/HIV in sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health 2016; 16:1069. [PMID: 27724886 PMCID: PMC5057258 DOI: 10.1186/s12889-016-3715-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/23/2016] [Indexed: 11/18/2022] Open
Abstract
Background School-based sexual health education has the potential to provide an inclusive and comprehensive approach to promoting sexual health among young people. We reviewed evaluations of school-based sexual health education interventions in sub-Saharan Africa to assess effectiveness in reducing sexually transmitted infections and promoting condom use. Methods We searched ten electronic databases, hand-searched key journals, and reference lists of included articles for potential studies. Data were extracted on outcomes, intervention characteristics, methods and study characteristics indicative of methodological quality. Where possible, data were synthesized using random effect meta-analysis. Intervention features found predominantly in effective interventions were noted. Results The initial search retrieved 21634 potentially relevant citations. Of these, 51 papers reporting on 31 interventions were included. No evaluation reported statistically significant effects on the incidence or prevalence of Human Immunodeficiency Virus and Herpes Simplex Virus 2 infections. However, intervention participants reported statistically significant greater condom use in both randomised controlled trials and non-randomised trials for short (less than 6 months) follow-up periods (OR = 1.62, 95 % CI = 1.03–2.55 and OR = 2.88, 95 % CI = 1.41–5.90 respectively). For intermediate (6–10 months) and long-term (more than 10 months) follow-up periods, the effect was statistically significant (OR = 1.40, 95 % CI = 1.16–1.68) and marginally significant (OR = 1.22, 95 % CI = 0.99–1.50) among the randomised trials respectively. Only 12 of the 31 interventions reported implementation details, out of which seven reported on fidelity. Conclusion School-based sexual health education has the potential to promote condom use among young people in sub-Saharan Africa. However, further work is needed to develop and evaluate interventions that have measurable effects on sexually transmitted infections. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3715-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Sadiq Sani
- Psychology Applied To Health, University of Exeter Medical School, College House, St Lukes Campus, Exeter, EX1 2 LU, UK.
| | - Charles Abraham
- Psychology Applied To Health, University of Exeter Medical School, College House, St Lukes Campus, Exeter, EX1 2 LU, UK
| | - Sarah Denford
- Psychology Applied To Health, University of Exeter Medical School, College House, St Lukes Campus, Exeter, EX1 2 LU, UK
| | - Susan Ball
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2 LU, UK
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Meagley K, Schriver B, Geary RS, Fielding-Miller R, Stein AD, Dunkle KL, Norris SA. The gender dimensions of social networks and help-seeking behaviors of young adults in Soweto, South Africa. Glob Health Action 2016; 9:31138. [PMID: 27265147 PMCID: PMC4911713 DOI: 10.3402/gha.v9.31138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 11/17/2022] Open
Abstract
Background Young people constitute a major proportion of the general population and are influenced by a variety of factors, especially in regards to seeking help. An understanding of help-seeking behaviors among young people is important for designing and implementing effective targeted health services. Methods We conducted in-depth interviews with 23 young adults aged 21–22 years in Soweto, South Africa, to explore the gender dimensions of social networks and help-seeking behaviors. Results We found that young men had larger peer social networks than young women and that young women's social networks centered on their households. For general health, both young men and young women often sought help from an older, maternal figure. However, for sexual health, young men consulted their group of peers, whereas young women were more likely to seek information from one individual, such as an older female friend or family member. Conclusion These differences in help-seeking behaviors have important implications for the delivery of health information in South Africa and how health promotion is packaged to young men and women, especially for sexual and reproductive health issues. Peer educators might be very effective at conveying health messages for young men, whereas women might respond better to health information presented in a more confidential setting either through community health workers or mHealth technologies. Provision of or linkage to health services that is consistent with young people's health-seeking behavior, such as using peer educators and community health care workers, may increase the reach and utilization of these services among young people.
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Affiliation(s)
- Kathryn Meagley
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Brittany Schriver
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa.,Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rebecca S Geary
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa.,Department of Population Studies, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Fielding-Miller
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aryeh D Stein
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa.,Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristin L Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa;
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Chandra-Mouli V, Lane C, Wong S. What Does Not Work in Adolescent Sexual and Reproductive Health: A Review of Evidence on Interventions Commonly Accepted as Best Practices. GLOBAL HEALTH, SCIENCE AND PRACTICE 2015; 3:333-40. [PMID: 26374795 PMCID: PMC4570008 DOI: 10.9745/ghsp-d-15-00126] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/27/2015] [Indexed: 11/23/2022]
Abstract
Youth centers, peer education, and one-off public meetings have generally been ineffective in facilitating young people’s access to sexual and reproductive health (SRH) services, changing their behaviors, or influencing social norms around adolescent SRH. Approaches that have been found to be effective when well implemented, such as comprehensive sexuality education and youth-friendly services, have tended to flounder as they have considerable implementation requirements that are seldom met. For adolescent SRH programs to be effective, we need substantial effort through coordinated and complementary approaches. Unproductive approaches should be abandoned, proven approaches should be implemented with adequate fidelity to those factors that ensure effectiveness, and new approaches should be explored, to include greater attention to prevention science, engagement of the private sector, and expanding access to a wider range of contraceptive methods that respond to adolescents’ needs.
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Affiliation(s)
| | - Catherine Lane
- United States Agency for International Development, Bureau for Global Health, Office of Population and Reproductive Health, Washington DC, USA
| | - Sylvia Wong
- United Nations Population Fund, New York, NY, USA
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Mu W, Zhao Y, Khoshnood K, Cheng Y, Sun X, Liu X, Xu W, Wang S, Ma Y, Zhang F. Knowledge and perceptions of sexual and reproductive health and HIV among perinatally HIV-infected adolescents in rural China. AIDS Care 2015; 27:1137-42. [PMID: 25894204 DOI: 10.1080/09540121.2015.1032206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Due to the success of highly active antiretroviral therapy, more children infected with HIV perinatally are living to adolescence. This brings new challenges on sexual and reproductive health (SRH) needs and psychosocial support specific to adolescents. To improve such efforts on long-term care of this vulnerable population, we assessed SRH and HIV knowledge and perceptions among perinatally HIV-infected adolescents (PHIVA). This descriptive cross-sectional study was conducted between July and September 2013 in a rural HIV clinic. A structured questionnaire focusing on SRH and HIV was administered to 124 PHIVA attending quarterly medical visit. Multivariable logistic regression was used to detect associated factors with knowledge acquisition. Among participants, 79% had never discussed puberty development or sexuality with parents. Over 50% had never heard of condoms and 20% reported not having any informational source of SRH and HIV knowledge. Only 5% correctly answered all questions regarding HIV knowledge and pregnancy, with 18% correctly answered questions regarding contraception. Adolescents older than age of 15 and who had been disclosed of HIV status were more likely to acquire correct knowledge of SRH and HIV. Most PHIVA did not report having access to comprehensive information on SRH and HIV, in part because of the early death of caretakers or unfavorable family status. Further integration of SRH services with HIV treatment programs is needed to provide comprehensive care for adolescents and prepare them for the transition to adult care.
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Affiliation(s)
- Weiwei Mu
- a Division of Treatment and Care , National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention , Beijing , China
| | - Yan Zhao
- a Division of Treatment and Care , National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention , Beijing , China
| | - Kaveh Khoshnood
- b Yale School of Public Health , Yale University , New Haven , CT , USA
| | - Yuewu Cheng
- c HIV/AIDS Department, Shang Cai Country Center for Disease Control and Prevention , Henan , China
| | - Xin Sun
- a Division of Treatment and Care , National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention , Beijing , China
| | - Xia Liu
- a Division of Treatment and Care , National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention , Beijing , China
| | - Wenqing Xu
- d Department of HIV/AIDS , UNICEF , Beijing , China
| | - Shuiwang Wang
- c HIV/AIDS Department, Shang Cai Country Center for Disease Control and Prevention , Henan , China
| | - Ye Ma
- a Division of Treatment and Care , National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention , Beijing , China
| | - Fujie Zhang
- a Division of Treatment and Care , National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention , Beijing , China.,e Infectious Disease Department, Beijing Ditan Hospital , Capital Medical University , Beijing , China
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Decat P, Nelson E, De Meyer S, Jaruseviciene L, Orozco M, Segura Z, Gorter A, Vega B, Cordova K, Maes L, Temmerman M, Leye E, Degomme O. Community embedded reproductive health interventions for adolescents in Latin America: development and evaluation of a complex multi-centre intervention. BMC Public Health 2013; 13:31. [PMID: 23311647 PMCID: PMC3599131 DOI: 10.1186/1471-2458-13-31] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/08/2013] [Indexed: 12/03/2022] Open
Abstract
Background Adolescents in Latin America are at high risk for unwanted and unplanned pregnancies, which often result in unsafe abortions or poor maternal health outcomes. Both young men and women in the region face an increased risk of sexually transmitted infections due to inadequate sexual and reproductive health information, services and counselling. To date, many adolescent health programmes have targeted a single determinant of sexual and reproductive health. However, recent evidence suggests that the complexity of sexual and reproductive health issues demands an equally multi-layered and comprehensive approach. Methods This article describes the development, implementation and evaluation design of the community-embedded reproductive health care for adolescents (CERCA) study in three Latin American cities: Cochabamba (Bolivia), Cuenca (Ecuador) and Managua (Nicaragua). Project CERCA’s research methodology builds on existing methodological frameworks, namely: action research, community based participatory research and intervention-mapping. The interventions in each country address distinct target groups (adolescents, parents, local authorities and health providers) and seek improvement of the following sexual health behaviours: communication about sexuality, sexual and reproductive health information-seeking, access to sexual and reproductive health care and safe sexual relationships. In Managua, we implemented a randomised controlled study, and in Cochabamba and Cuenca we adopted a non-randomised controlled study to evaluate the effectiveness of Project CERCA interventions, in addition to a process evaluation. Discussion This research will result in a methodological framework that will contribute to the improved design and implementation of future adolescent sexual and reproductive health interventions. Trial registration ClinicalTrials.gov (NCT01722084)
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Affiliation(s)
- Peter Decat
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185 UZP 114, Gent 9000, Belgium.
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Michielsen K. Limited effectiveness of HIV prevention for young people in sub-Saharan Africa: studying the role of intervention and evaluation. Facts Views Vis Obgyn 2013; 5:196-208. [PMID: 24753945 PMCID: PMC3987367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
On average, 2,500 young people (15-24 years) get -infected with HIV every day; 80% of which live in sub-Saharan Africa. Since no cure or vaccine is available, reducing sexual risk behaviour in this group is crucial in tackling the epidemic. The general objective of this doctoral study was to improve the effectiveness of HIV prevention interventions for young people in sub-Saharan Africa. First, we assessed the overall effectiveness of such interventions (systematic literature review, meta-analysis). Secondly, we evaluated a school-based peer-led HIV prevention interventions in Rwanda (longitudinal, non-randomized controlled trial), to get insight into how interventions are developed, implemented and evaluated. While the first two objectives demonstrated limited effectiveness, the third objective aimed to identify reasons for this limited effectiveness: a) baseline characteristics of -respondents that predict participation were identified (using data from objective 2); b) we studied determinants of young people's sexual behavior using a qualitative 'mailbox study' that assessed the spontaneous thoughts of Rwandan adolescents on sexuality; c) we assessed the role of one specific structural factor: -education (literature review and analysis of existing datasets); d) we assessed the theoretical underpinnings of existing HIV prevention interventions for young people in sub-Saharan Africa (literature review). Based on these studies, we discuss two main reasons for the observed limited effectiveness: factors associated with the intervention (strong focus on cognitions and moral, and implementation issues), and with evaluation (design, power, indicators). Recommendations for improving interventions, evaluations and for further research are provided.
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Affiliation(s)
- K. Michielsen
- International Centre for Reproductive Health, De Pintelaan 185 UZP114, 9000 Gent, Belgium
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