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Twitty TD, Hitch AE, Marais L, Sales JM, Sharp C, Cloete J, Lenka M, Rani K, Gause NK, Brown JL. Pregnancy and STI/HIV prevention intervention preferences of South African adolescent girls: findings from a cultural consensus modelling qualitative study. CULTURE, HEALTH & SEXUALITY 2024; 26:191-207. [PMID: 37022107 DOI: 10.1080/13691058.2023.2194357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
South African adolescent girls experience high rates of unintended pregnancy and sexually transmitted infections including HIV. To inform culturally-tailored dual protection interventions to prevent both unintended pregnancy and STIs/HIV, this study qualitatively examined girls' sexual health intervention preferences. Participants were aged 14-17 years old and Sesotho-speaking (N = 25). To elucidate shared cultural beliefs, individual interviews examined participants' perceptions about other adolescent girls' pregnancy and STI/HIV prevention intervention preferences. Interviews were conducted in Sesotho and translated into English. Two independent coders identified key themes in the data using a conventional content analysis approach with discrepancies resolved by a third coder. Participants indicated that intervention content should include efficacious pregnancy and STI/HIV prevention methods and ways to navigate peer pressure. Interventions should be accessible, avoid criticism and provide high-quality information. Preferred intervention formats included online, SMS/text, or delivery by social workers or older, knowledgeable peers, with mixed acceptability for delivery by parents or same-age peers. Schools, youth centres and sexual health clinics were preferred intervention settings. Results highlight the importance of cultural context in tailoring dual protection interventions to address the reproductive health disparities among adolescent girls in South Africa.
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Affiliation(s)
- T Dylanne Twitty
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Anthony E Hitch
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Lochner Marais
- Centre of Development Support, Economic and Management, University of the Free State, Bloemfontein, Republic of South Africa
| | - Jessica M Sales
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Carla Sharp
- Centre of Development Support, Economic and Management, University of the Free State, Bloemfontein, Republic of South Africa
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jan Cloete
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Molefi Lenka
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kholisa Rani
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nicole K Gause
- University Counseling & Wellbeing Center, Duquesne University, Pittsburgh, PA, USA
| | - Jennifer L Brown
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
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Jonas K, Bergh K, Duby Z, Mangoale K, Mogari N, Kuo C, Reddy T, Mathews C. Using prevention cascades to investigate coverage of contraception services among young women enrolled in a large-scale combination HIV prevention program in South Africa. Contraception 2024; 130:110307. [PMID: 37863465 DOI: 10.1016/j.contraception.2023.110307] [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] [Received: 05/15/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES We investigated the coverage of contraception services (excluding condoms) to prevent unintended pregnancy among young women and girls aged 15 to 24 years who were beneficiaries of one of the two largest combination HIV and pregnancy prevention program in South Africa. STUDY DESIGN We invited 2160 randomly sampled beneficiaries who were living in six of the 12 program districts across six provinces to participate in a telephone survey. We created pregnancy prevention coverage cascades and conducted univariate and multivariable analyses to identify key barriers and facilitators associated with each step of the cascade. RESULTS We achieved a response rate of 23.8%, resulting in 515 respondents, of whom 303 had sex in the 6 months before the survey. Of this subsample, 80.4% had access to contraception services, 60.6% had access and motivation to use contraceptives, and 21.9% had access to, motivation to use, and effectively used contraceptives. Distance to travel to services and not ever being offered contraceptives by health workers were access barriers, while low pregnancy risk perception was a barrier to motivation. CONCLUSIONS Most respondents had access to and were motivated to use contraceptives other than condoms but were not effectively using them. Having been offered contraceptives facilitated better access, while distance to the services was a barrier, suggesting the importance of improving supply-side interventions, such as increasing the number and accessibility of spaces where Sexual and Reproductive Health (SRH) services are offered. We recommend longitudinal behavioral counseling for young people, especially adolescents, as well as risk reduction and information-tailored interventions. IMPLICATIONS Pregnancy prevention cascades are a promising tool to monitor progress toward universal access to contraception services and to identify barriers that need to be addressed to achieve the effective use of contraceptives.
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Affiliation(s)
- Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Kate Bergh
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kgahliso Mangoale
- Networking HIV and AIDS Community of Southern Africa (NACOSA), Cape Town, South Africa
| | - Neo Mogari
- Networking HIV and AIDS Community of Southern Africa (NACOSA), Cape Town, South Africa
| | | | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Agu IC, Agu C, Mbachu C, Onwujekwe O. Impact of a capacity-building intervention on views and perceptions of healthcare providers towards the provision of adolescent sexual and reproductive health services in southeast Nigeria: a cross-sectional qualitative study. BMJ Open 2023; 13:e073586. [PMID: 38000827 PMCID: PMC10679974 DOI: 10.1136/bmjopen-2023-073586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES Negative views of healthcare providers towards adolescent sexual and reproductive health (SRH) services deter adolescents from seeking vital SRH services. This paper assessed the impact of an intervention on the views and perceptions of healthcare providers towards the provision of adolescent SRH services. DESIGN AND SETTING A descriptive, cross-sectional, qualitative study was conducted between 14 October and 19 November 2021 in six local government areas (LGAs) in Ebonyi state, southeast Nigeria, after the implementation of an intervention comprising of training and supportive supervision. PARTICIPANTS AND DATA COLLECTION Data were collected through: (1) two in-depth interviews (IDIs) with LGA healthcare managers; (2) six IDIs with LGA adolescent health programme managers; (3) two focus group discussions (FGDs) with 15 primary healthcare facility managers; (4) two FGDs with 20 patent medicine vendors and (5) two FGDs with 17 community health volunteers. A total of six FGDs were held with 52 healthcare providers. The interviews were conducted using pretested interview guides. Transcripts were coded in NVivo (V.12) and themes were identified through inductive analysis. RESULTS As a result of the intervention, most healthcare providers started recognising the rights of adolescents to obtain contraceptive services and no longer deny them access to contraceptive services. The providers also became friendlier and were no longer harsh in their interactions with adolescents. There were some unique findings relative to whether the providers were formal or informal healthcare providers. It was found that the informal healthcare providers were bolder and more comfortable delivering SRH services to adolescents and reported improved patronage by the adolescents. The formal healthcare providers made their facilities more conducive for adolescents by creating safe spaces and introducing extracurricular activities. CONCLUSION These findings highlight the importance of the constant capacity building of both formal and informal healthcare providers, which can address healthcare providers' biases, views and perceptions of delivering SRH services to adolescents.
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Affiliation(s)
- Ifunanya Clara Agu
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chibuike Agu
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Chinyere Mbachu
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria-Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria-Enugu Campus, Enugu, Nigeria
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Mbengo F, Adama E, Towell-Barnard A, Zgambo M. "A spade was called a spade … ": Youth and intervention implementers' perceptions of a resilience-based HIV-prevention intervention for youth in South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:145-156. [PMID: 37539638 DOI: 10.2989/16085906.2023.2233496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/01/2023] [Indexed: 08/05/2023]
Abstract
The youth (15-24 years old) in South Africa remain at high risk of HIV infection despite varied efforts to control the disease. An understanding of the perspectives of relevant stakeholders of HIV-prevention interventions targeting the youth is important to guide research, policy and practice aimed at improving these interventions. This study explores youth and intervention implementers' perceptions of a resilience-based HIV-prevention intervention (You Only Live Once) aimed at reducing risky sexual behaviours among the youth in South Africa. Semi-structured interviews were conducted with 10 young people who participated in the intervention, and four intervention implementers at a not-for-profit organisation in Maluti-a-Phofung Local Municipality, South Africa. Data were analysed using thematic analysis. Three main themes emerged from the data: (1) Acceptability and impact of the intervention; (2) Factors influencing intervention implementation; and (3) Recommendations to improve intervention implementation. These findings provide insights into the acceptability, impact, barriers and facilitators of resilience-based HIV-prevention interventions for the youth in South Africa and similar contexts, and how implementation of these interventions could be enhanced. The findings can help researchers, policy makers and health care practitioners in the field of HIV prevention to improve interventions targeting young people.
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Affiliation(s)
- Fungai Mbengo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Esther Adama
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | | | - Maggie Zgambo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
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Bergh K, Jonas K, Duby Z, Govindasamy D, Mathews C, Reddy T, Slingers N, Whittle G, Abdullah F. Factors Associated with COVID-19 Vaccine Uptake among Schoolgoing Adolescent Girls and Young Women in South Africa. Vaccines (Basel) 2023; 11:1581. [PMID: 37896983 PMCID: PMC10610973 DOI: 10.3390/vaccines11101581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: By October 2022, vaccination rates with at least one dose of a COVID-19 vaccine were low among adolescent girls aged 12-17 (38%) and young women aged 18-34 (45%) in South Africa. This study aimed to measure and identify barriers to and facilitators of motivation to take up, access to, and uptake of COVID-19 vaccines among schoolgoing adolescent girls and young women in two districts in South Africa. (2) Methods: Using the theory of the HIV prevention cascade, we conceptualised the relationship between motivation, access, and uptake of COVID-19 vaccines, and associated barriers. Potential barriers and facilitators were identified using bivariate and multivariable Poisson regression. (3) Results: Among all 2375 participants, access was high (69%), but motivation (49%) and vaccination with at least one COVID-19 vaccine (45%) were lower. Fear of injections was a barrier to vaccine uptake (aRR 0.85 95% CI 0.82-0.88), while being tested for COVID-19 (aRR 2.10 95% CI 1.85-2.38) and believing that the COVID-19 vaccine was safe (aRR 1.31 95% CI 1.18-1.44) and would prevent you from getting very sick (aRR 1.11 95% CI 1.04-1.19) were facilitators. (4) Conclusions: The controversy about the value of vaccinating adolescents and the delay in vaccine rollout for adolescents and young adults may have contributed to fears about the safety and efficacy of COVID-19 vaccines, as well as a lack of motivation to get vaccinated.
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Affiliation(s)
- Kate Bergh
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
- Department of Psychology, University of Cape Town, Cape Town 7700, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
| | - Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban 4091, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria 0001, South Africa
| | - Granville Whittle
- Department of Basic Education, Government of South Africa, Pretoria 0001, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria 0001, South Africa
- Division of Infectious Diseases, Department of Internal Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria 0002, South Africa
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Sensoy Bahar O, Nabunya P, Namuwonge F, Samtani S, Ssentumbwe V, Namuli F, Magorokosho N, Ssewamala FM. "It gives you a road map of what to do to solve your problems": acceptability of a combination HIV prevention intervention among adolescent girls in Uganda. BMC Public Health 2023; 23:249. [PMID: 36747149 PMCID: PMC9901100 DOI: 10.1186/s12889-023-15083-2] [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: 10/14/2022] [Accepted: 01/18/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The HIV burden remains a critical public health concern and adolescent girls are at significantly higher risk compared to the general adult population. Similar to other sub-Saharan African countries, Uganda reports high HIV prevalence among adolescent girls and young women. Yet, both evidence-based HIV prevention interventions and their acceptability among adolescent girls have not been widely studied. In this study, we examined the acceptability of the Suubi4Her intervention, an evidence-based combination intervention aimed at reducing HIV risk among adolescent girls in Uganda. METHODS We conducted semi-structured in-depth interviews with 25 adolescent girls upon intervention completion to explore their experiences with the Suubi4Her intervention that was tested in a clinical trial in Uganda (2017-2023). Specifically, we explored their decision-making process for participating in the intervention, experiences with program attendance, and their feedback on specific intervention characteristics. Informed by the Theoretical Framework of Acceptability, the data were analyzed using thematic analysis. RESULTS The main motivation for participation was access to health-related information, including information on STIs, HIV, and pregnancy as well as information on banking, saving, and income-generating activities. Though many participants did not have any initial concerns, mistrust of programs, initial paperwork, caregiver's ability to commit time, concerns about ability to save, and HIV/STI and pregnancy testing were raised by some participants. Facilitators to session attendance included motivation to learn information, caregiver commitment, reminder calls, and incentives received for participation. The main challenges included household responsibilities and obligations, difficulty raising transport money, and weather challenges. Adolescent girls appreciated the group format and found the location and times of the sessions convenient. They also found the content relevant to their needs and noted positive changes in their families. CONCLUSIONS The results showed high intervention acceptability among adolescent girls. These findings have important programmatic and policy implications in Uganda, especially given the higher HIV prevalence among adolescent girls in the country. TRIAL REGISTRATION NCT03307226 (Registered: 10/11/17).
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Affiliation(s)
- Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, USA. .,International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Proscovia Nabunya
- grid.4367.60000 0001 2355 7002Brown School, Washington University in St. Louis, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - Flavia Namuwonge
- grid.4367.60000 0001 2355 7002Brown School, Washington University in St. Louis, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - Satabdi Samtani
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - Vicent Ssentumbwe
- grid.4367.60000 0001 2355 7002Brown School, Washington University in St. Louis, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - Florence Namuli
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Natasja Magorokosho
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - Fred M. Ssewamala
- grid.4367.60000 0001 2355 7002Brown School, Washington University in St. Louis, St. Louis, MO USA ,grid.4367.60000 0001 2355 7002International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
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