Lending a hand: developing a support structure for young migrants in South Africa and Uganda

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A significant proportion of young people in sub-Saharan Africa migrate to towns or cities, where they hope to find work and build their livelihood. Our aim is to develop and test the acceptability and feasibility of a protective support structure for young migrants (aged 14-24 years old) in urban settings in South Africa and Uganda as means of early intervention to reduce the harm of patterns of risk behaviour (sexual risk and violence) associated with youth migration. Specifically we will 1) establish a small peer supporter network in three sites (a small town in Uganda (Lukaya) and in South Africa (Mtubatuba) and an urban area (Mengo) in Kampala city in Uganda) to provide advice and support over the telephone to young migrants; 2) offer a drop-in centre or hub (a small rented shop or similar) staffed by a peer-supporter during the day and early evening who can provide information and onward referral to local health and social services, free condoms, access to a counsellor/nurse for advice and the use of a computer and printer for word processing (for letters and job applications) and 3) identify local (adult) champions and local resources/safe spaces to enable a supportive environment for the well-being adolescent and young people who are migrants. Our plans draw from our evidence base, gained through prior research in the two settings, and a Theory of Change which draws on a `protection-risk' conceptual framework. Our focus will be all young people who have migrated, with particular attention to new migrants (who are within six months of their move to the new location and particularly vulnerable to health-related risk and sexual exploitation) while still providing advice to migrants of longer standing, who may be planning a further move or trying to make a change in their employment. We will use mixed-methods to adapt, implement and evaluate the feasibility of an intervention. We will use participatory methods working with youth advisory groups in both countries already engaged in the design of this project, to develop and implement the intervention. Then we will conduct a mixed-methods process evaluation to assess which facets of the package are valued and test our assumptions about the challenges young migrants face and the appropriateness of the intervention offered. Finally, we will design a full-scale evaluation of the effectiveness and cost effectiveness of the feasible and acceptable elements of the intervention, which we anticipate will go on to be tested in a randomised control trial. The intervention is intended to support an individual migrant's ability to manage and adapt to their place of migration and identify the ways in which the key components of our intervention (positive role models/ "good" social network, safer environment, health and social support) may afford protection, supporting young migrants to demonstrate resilience with tangible impacts on health (e.g. safer sexual and reproductive health behaviours) and well-being (e.g. hope for the future).The work will be divided into four phases across 30 months: Phase 1 (months 1-3): recruitment of staff and other preparations; Phase 2 (months 4-9): Baseline assessment and co-designing the intervention with young people and other stakeholders; Phase 3 (months 10-21): Implementation of the intervention; Phase 4 (months 22-30): Analysis, dissemination and discussions on refinement of the intervention and, if the intervention is feasible, the design of a full-scale trial. On completion of the project we expect to have a contextually adapted, community-based, peer-delivered intervention, predicated on demonstrated resilience to improve health and well-being of mobile adolescents. We anticipate that this intervention will be scalable and reproducible in other settings in sub-Saharan Africa to reduce teenage pregnancy and the burden sexually transmitted infections including HIV-related morbidity and mortality in adolescent and young people.