“Adolescents (ages 10-19) and youth (ages 15-24) bear a disproportionate share of the HIV burden, especially in sub-Saharan Africa. However, little is known about what projects are doing to make their interventions adolescent- and youth-friendly and which interventions are effective for changing HIV- related outcomes in this age group.”
This compendium offers an overview of best practices for adolescent- and youth-friendly programme interventions in order to provide programme planners and policymakers with evidence-informed information to determine how to invest resources effectively to meet 90-90-90 targets for adolescents and youth (90 percent know their HIV status, 90 percent of those with diagnosed HIV infection will receive sustained antiretroviral therapy (ART), and 90 percent of those receiving ART will have viral suppression). The review of interventions had three objectives: (1) document knowledge of what is working and what is not working in terms of delivering adolescent- and youth-friendly HIV services, and why strategies and programme activities work or do not work; (2) identify useful lessons learned about key elements of successful adolescent- and youth-friendly HIV services; and (3) promote the use and adaptation of best practices for adolescent- and youth-friendly HIV services in order to improve the quality of HIV services delivered to young people and to attract adolescents and youth to retain them in those services. The review was conducted by MEASURE Evaluation to inform the United States Agency for International Development (USAID)’s mission to support HIV-positive adolescents and youth to live healthy lives. It is hoped that other organisations may be able to learn from the programmes and strategies described in this compendium to inform the development and implementation of similar approaches to adolescent- and youth-friendly service provision.
The 13 projects covered in the compendium were collated through a call for proposals on best practices and a review of peer-reviewed/grey literature in 22 U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)-supported countries. They are also projects that gave permission for them to be be summarised. A review group graded the projects using the following criteria: adolescent and youth involvement, relevance, effectiveness/impact, reach, feasibility, sustainability, replicability or transferability, ethical soundness, and efficiency. Seven best practices, four promising practices, and two emerging practices were identified, of which five provided strong evidence needed to recommend priorities for action. Projects with best practices included: (1) Adolescent-Friendly Voluntary Medical Male Circumcision Project in South Africa; (2) Fútbol para la Vida (FPV) (Deportes para la Vida) in Dominican Republic; (3) Mema kwa Vijana in United Republic of Tanzania, (4) One2One Integrated Digital Platform in Kenya; (5) Supporting Youth and Motivating Positive Action (SYMPA) in Democratic Republic of Congo; (6) Program H in Ethiopia and Namibia; and (7) Zvandiri Project in Zimbabwe. Projects with promising practices included: (1) Integrated Project against HIV/AIDS in Chibombo District, Zambia; (2) Project Accept in South Africa, United Republic of Tanzania, and Zimbabwe; (3) Sunbursts Project in Kenya; and (4) Toolkit and Training Manual for Transition of Care and Other Services for Adolescents with HIV (Kenya). Projects with emerging practices included: (1) Feel the Future, Malawi; and (2) Youth Voluntary Counseling and Testing, Botswana.
The projects fall into four groups: three clinic-based programmes with or without a community component; three clinic- and school-based programmes with or without a community component; six community-based programmes; and one mobile- or web-based programme. Using these categories, the compendium: summarises the features that make the programmes adolescent- and youth-friendly; discusses the programmes' impact on HIV outcomes; describes lessons learned; and considers factors that contribute to sustainability. A summary table gives each study location and programme name, specifies the type of programme and its intended population, describes the programme, and reviews best practices.
To mention just a few examples of how programmes made their projects adolescent and youth friendly, the review cites: the meaningful engagement of adolescents and youth in programme design and implementation; increasing accessibility to services by extending services to after-school hours; establishing adolescent centres run by trained adolescents and youth within health facilities; providing mobile HIV testing services in venues easily accessible to youth; and providing alternative ways of accessing information, counseling, or services (e.g., use of digital technologies through mobile or web-based platforms and cartoon videos).
As explained in the compendium, the projects examined set out to achieve a wide variety of outcomes. To synthesise the evidence of what works to improve adolescent/youth health outcomes, projects were classified as having either a rigorous or non-rigorous evaluation design. Rigorous evaluation designs included experimental studies with random assignment to an intervention or control condition (e.g., randomised controlled trial) or quasi experimental designs involving comparison groups without random assignment. Pre–post designs were classified as non-rigorous evaluation designs. The project outcomes are then discussed in relation to: effectiveness on changing HIV-related knowledge and attitudinal outcomes; effectiveness on HIV-related behavioural outcomes (including sexual behaviours, condom use, intimate partner violence, HIV testing, disclosure, and ART adherence); non effectiveness for HIV-related behavioural outcomes; effectiveness for HIV-related biological outcomes; and non effectiveness for HIV-related biological outcomes. Overall, the report highlights the lack of integrated monitoring and evaluation (M&E) systems among the projects submitted, a concern also echoed by the projects themselves.
The following were identified by projects as factors that contributed to the sustainability of their adolescent- and youth-friendly practices:
- Integration of project activities into existing health systems and government/community structures
- Community buy-in and advocacy for the project
- Collaborative relationships and partnerships
- Coordinating funding from multiple sources to sustain the project
- Evaluation results demonstrating that the project is making a difference
The following are some of the lessons learned:
Clinic-based interventions with or without a community component:
- When implementing curricula among HIV-positive youth, it is to be noted that the educational level of participants can be variable. Outside of school-based settings, specific activities requiring written responses would need to be adapted for adolescents and youth who are unable to write.
- In a context where few health facilities offer HIV services that are tailored to adolescents and youth, counselors are able to reach more adolescents and youth during mobile testing as opposed to fixed-site service delivery.
Clinic-based and school-based interventions with or without a community component:
- Community involvement and consultations are critical for creating an enabling environment for recruitment of in-school adolescents for voluntary medical male circumcision (VMMC) services.
- A single training during scale-up of a school-based curriculum appears to be insufficient to impart skills required for teaching the psychosocial aspects of the curriculum. Systematic pre-service training of teachers would be more cost-efficient.
- Involvement of local people and community-based governmental and non-governmental organisations is critical to success in improving HIV-related knowledge and attitudes among adolescents and youth.
- There is no magic bullet for community mobilisation. Strategies used in varying combinations included securing stakeholder buy-in, building community coalitions, directly engaging the community, fostering community participation in project-related activities, raising community awareness, involving community leaders, and creating partnerships with local organisations.
Mobile and web-based interventions:
- Mobile platforms are a crucial delivery point for adolescents and youth because these age groups favour them and because they are anonymous. Anonymity makes it easier for adolescents and youth to ask questions and seek advice about health issues.
Click here for a companion document to this Best Practice Compendium - “Guidelines on Best Practices for Adolescent- and Youth-Friendly HIV Services - An Examination of 13 Projects in PEPFAR-Supported Countries”.
MEASURE Evaluation website on July 11 2017.