“Yathu Yathu” (For us, by us!): an innovative, co-designed intervention to provide peer-led, community-based sexual and reproductive health services to adolescents and young people in Lusaka, Zambia.

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Young people in a study community

Context

Adolescents and young adults (AYPs) in Eastern and Southern Africa aged 15 to 24 years are disproportionately affected by HIV, which is the leading cause of HIV. deaths among adolescents in Africa. Antiretroviral treatment (ART) can reduce the risk of HIV transmission and improve survival. However, AYPs need better access and utilization of HIV prevention and health care services. Unfortunately, AYPs are less likely to access HIV services. They also perform worse across the HIV care and prevention continuum

What we did in our research

The AYP program is designed to improve AYP outcomes. Yathu Yathu The study (YY) was conducted in Lusaka, Zambia to deliver sexual and reproductive health (SRH) services designed by AYP. The design of YY began with consultations with young people. They spoke and we listened. During the training phase of working with AYPs, many expressed hesitation to use services provided by health workers out of fear. They also explained that this was due to their reluctance to seek services from health facilities for fear of being reprimanded and seen by their parents or community.

AYP knows their wants and needs in terms of SRH, what services they wish to receive, where and by whom they wish to receive and provide them.

In the community, it's much better... [AYP] Most people do not feel comfortable coming to the clinic [health facility] They are uncomfortable with workers [HCWs] Some people say they are afraid of meeting someone they know. (young woman, 23 years old)

“…Sometimes we may need other young people [peers] We know they test people, but we don't. [offering HIV testing], They know it too because they go through what we do” (young man, 15-17 years old)

We implemented the YY interventions based on the feedback we received from AYP, down to the color palette and logo design used in the spaces that are community-based, called YY Hubs. HIV testing, contraceptives and STIs were provided, as well as a brief risky drinking intervention. A new incentive system has been introduced, called the “prevention points system”. This included a Prevention Points Card (PPC), which allowed AYP members to “earn” points by using each service and then redeem those points for “rewards.” The rewards were inexpensive items like soap, toothbrushes, and toothpaste, as well as workbooks, YY brand t-shirts, etc. The goal was to get AYPs to take advantage of the service and track its usage.

The intervention was tested to see if it increased access to SRH. We conducted a cluster randomized study (CRT), comparing young people's knowledge about their HIV status after two years of receiving YY services in ten randomly selected geographic areas. (Intervention zones, those with access to YY.) With those in control zones (those who received standard care, local health facilities adapted for young people). We also used PPC data to estimate the impact of the intervention on SRH coverage for AYP.

Results

COVID-19, like everywhere else, hit Zambia, causing service interruptions and a change in response. Despite this,

• 74% of AYPs from intervention zones having accepted a PPC accessed a minimum service in the YY Hubs compared to 11% from control zones requesting a local service.
• At least 64% of AYPs in intervention areas will have access to at least one key SRH service, namely HIV testing, condom collection, contraceptive use and voluntary medical male circumcision. [VMMC]Pre-exposure prophylaxis [PrEP] Antiretroviral therapy can be initiated [ART] Participants in the control area were 5% less likely to be involved.
• This is largely due to the increased use of HIV testing services. The effect of HIV testing was greater among girls and boys aged 15 to 19 than among men and women aged 20 to 24, but all age groups found the intervention acceptable and easy to access.

“…The environment is there It's very usefulThe people here are very friendly and the advisors have a lot of experience. When you arrive, they will be the first to mention the food. . “I know that everything I say here will be kept secret and no one will hear it. » (Young woman aged 20 to 24)

• A cross-sectional study of approximately 2000 AYPs was used. to measure the impact of Yathu Yathu on knowledge of HIV. Using survey data, we found that a large number of AYPs living in intervention areas (63 to 81 %s) reported their HIV status, compared to 35 to 63 %s of AYPs who lived in areas intervention. in control areas.

Conclusions

Yathu Yathu demonstrated that bringing SRH into communities can reach more young people, especially with HIV testing for “closure”. “down the tap” and prevent new HIV infections as World AIDS Day approaches, it is important to engage AYPs and provide them with services tailored to their needs

See the following: Zambart website For more information, click here please.

Have fun ! Visit our website to see all the videos, including the hub tour. Youtube channel!