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

撒哈拉以南非洲地区有很大一部分年轻人迁移到城镇或城市，希望在那里找到工作并建立自己的生计。我们的目标是开发和测试南非和乌干达城市环境中年轻移民（14-24岁）保护性支持结构的可接受性和可行性，作为早期干预的手段，以减少与青年移民相关的风险行为模式（性风险和暴力）的危害。具体来说，我们将1)在三个地点（乌干达的一个小镇（卢卡亚）、南非的一个小镇（姆图巴图巴）和乌干达坎帕拉市的一个城区（蒙戈））建立一个小型同伴支持者网络，通过电话向年轻移民提供建议和支持；2)提供一个求助中心或中心（一个租来的小商店或类似的地方），在白天和傍晚由一名同伴支持者提供工作人员，他们可以提供信息并转介到当地卫生和社会服务机构，提供免费避孕套；获得咨询师/护士的咨询，使用电脑和打印机进行文字处理（信件和工作申请）；3)确定当地（成人）支持者和当地资源/安全空间，为移民青少年和年轻人的福祉创造支持性环境。我们的计划基于我们的证据基础，通过之前对两种环境的研究获得，以及基于“保护-风险”概念框架的变化理论。我们的重点将是所有移徙的年轻人，特别关注新移徙者（他们在搬到新地点的六个月内，特别容易受到与健康有关的风险和性剥削），同时仍向可能计划进一步迁移或试图改变就业的长期移徙者提供咨询。我们将使用混合方法来适应、实施和评估干预措施的可行性。我们将采用参与式方法，与两国已经参与该项目的设计的青年咨询小组合作，制定和实施干预措施。然后，我们将进行混合方法过程评估，以评估一揽子计划的哪些方面受到重视，并测试我们对年轻移民面临的挑战和所提供干预措施的适当性的假设。最后，我们将对干预措施的可行性和可接受要素的有效性和成本效益进行全面评估，我们预计将在随机对照试验中进行测试。干预措施的目的是支持移徙者个人管理和适应其移徙地点的能力，并确定我们干预措施的关键组成部分（积极的榜样/ “良好的”社会网络、更安全的环境、健康和社会支持）可以提供保护的方式，支持青年移徙者展示复原力，对健康（例如更安全的性健康和生殖健康行为）和福祉（例如对未来的希望）产生切实影响。这项工作将分为四个阶段，共30个月：第一阶段（1-3个月）：招聘工作人员和其他准备工作；第二阶段（4-9个月）：基线评估并与年轻人和其他利益相关者共同设计干预措施；第三阶段（10-21个月）：实施干预；第4阶段（22-30个月）：分析、传播和讨论干预措施的改进，如果干预措施可行，则设计全面试验。在项目完成后，我们期望有一种适应具体情况的、以社区为基础的、同侪提供的干预措施，其基础是显示出改善流动青少年健康和福祉的复原力。我们预计，这一干预措施将可在撒哈拉以南非洲的其他环境中推广和复制，以减少青少年怀孕和性传播感染的负担，包括青少年和年轻人中与艾滋病毒相关的发病率和死亡率。

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.