Session: STIs: a global health crisis, but not a lost cause
O10.4 - Using a candidacy framework to investigate barriers and facilitators of a tailored HIV prevention and community based sexual and reproductive health intervention rural South Africa
Social Science Research Africa Health Research Institute Mtubatuba, KwaZulu-Natal, South Africa
Background: Adolescents and young adults (AYA) in South Africa (SA) have a high burden of HIV, teenage pregnancy, and sexually transmitted infection (STI), in part due to poor engagement with services. We tested the hypothesis that integrated sexual and reproductive health (SRH), including home-based STI testing with or without peer-led tailored support would improve access to mobile adolescent and youth friendly services (AFYS) in the Isisekelo Sempilo Clinical Trial in rural South Africa. We used a candidacy framework to explore how AYA used intervention components to navigate service uptake. Methods: Between 2020 and 2021, following informed consent, semi-structured telephone interviews were conducted with young people aged 16 to 35 (n=52) purposively selected from each arm of the Trial, representing those who refused the intervention (n=8), peer navigators offering the intervention (n=18) and clinical staff who delivered the AFYS (n=20). Data were transcribed, translated from IsiZulu to English and analysed thematically using the stages in the adapted candidacy framework, (see figure 1), to see the extent to which, and what components of, the intervention helped young people engage with tailored HIV prevention and SRH care. Results: AYA described having staff in the mobile clinics and in the field that spoke the local colloquial language facilitated Identification, Navigation and Utilization (stages 1, 2, and 3). STI testing and receiving results in the privacy of their home was appealing to young people and facilitated stages 3 and 5 (Evaluation). However, some AYA remained concerned about confidentiality and privacy if they were unable to conceal the tests from household members. This became a barrier to on-going use of AYFS. Peer navigators were seen to facilitate at all stages of the candidacy framework as health promotion improved health literacy, and peer navigators facilitated attendance at AFYS. Referral slips offered by the research assistants at enrolment (enhanced standard of care in all trial arms) were found to facilitate convenient access to the AFYS which facilitated Navigation and Utilization (stages 2 and 3). Conclusion: SRH uptake was facilitated by decentralized approaches. home-based STI testing, peer support and referral to mobile AFYS. Fears around privacy remain a barrier.
