Putting youth at the centre: co-design of a community-based intervention to improve HIV outcomes among youth in Zimbabwe.
Putting youth at the centre: co-design of a community-based intervention to improve HIV outcomes among youth in Zimbabwe.
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DOI：
10.12688/wellcomeopenres.17531.2
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发表时间：
2022
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背景：青年人的艾滋病毒结果不成比例地差。我们的目标是与青年人共同设计一项以社区为基础的干预措施，以改善16-24岁人群的艾滋病毒结果，并将在津巴布韦进行试验。 研究方法：我们对青少年、家庭成员、社区守门人和医疗保健提供者进行了90次深入访谈，以了解接受现有艾滋病毒服务的障碍。访谈为干预措施纲要提供了信息，通过两次有青年参加的讲习班和随后的试点测试对该纲要进行了完善。 结果如下：与会者认为现有的服务难以获得，没有吸引力：保健设施被认为是为“病人”服务的，以艾滋病毒为中心，由判断力强的提供者提供服务。为克服这些障碍而提出的干预措施的特点包括：一）在仅限青年人的社区空间提供服务;二）将艾滋病毒服务与更广泛的保健服务相结合;三）非评判性的熟练保健提供者;四）鼓励参加的娱乐活动;五）量身定制的时间安排和外联活动。干预框架以三个核心支柱为基础，即优化获得服务的机会（以社区为基础的方便青年的环境）;接受和可接受性（服务品牌、保密性和社会活动）;以及内容和质量（艾滋病毒综合护理级联、高质量产品和训练有素的提供者）。 结论：如果要实现获得、吸收和覆盖，持续的有意义的青年参与对于设计艾滋病毒干预措施至关重要。
Background: Youth have disproportionately poor HIV outcomes. We aimed to co-design a community-based intervention with youth to improve HIV outcomes among 16–24 year-olds, to be trialled in Zimbabwe. Methods: We conducted 90 in-depth interviews with youth, family members, community gatekeepers and healthcare providers to understand the barriers to uptake of existing HIV services. The interviews informed an outline intervention, which was refined through two participatory workshops with youth, and subsequent pilot-testing. Results: Participants considered existing services inaccessible and unappealing: health facilities were perceived to be for ‘sick people’, centred around HIV and served by judgemental providers. Proposed features of an intervention to overcome these barriers included: i) delivery in a youth-only community space; ii) integration of HIV services with broader health services; iii) non-judgemental skilled healthcare providers; iv) entertainment to encourage attendance; and v) tailored timings and outreach. The intervention framework stands on three core pillars, based on optimizing access (community-based youth-friendly settings); uptake and acceptability (service branding, confidentiality, and social activities); and content and quality (integrated HIV care cascade, high quality products, and trained providers). Conclusions: Ongoing meaningful youth engagement is critical to designing HIV interventions if access, uptake, and coverage is to be achieved.