Feasibility of implementing an integrated hybrid model of service delivery for AGYW sexual and reproductive health in South Africa

在南非，少女和年轻妇女面临着重大的健康挑战，包括艾滋病毒感染、少女意外怀孕和性传播疾病。在为老年妇女接受和利用性健康和生殖健康服务方面存在挑战，卫生系统错失了许多向老年妇女提供预防和护理的机会。决策者正在重新推动服务整合，将性健康和生殖健康服务与新出现的艾滋病毒预防和治疗服务结合起来，此外还在初级卫生保健一级扩大获得性传播感染的预防、护理和治疗的机会。目前孤立的服务提供模式增加了诊所设施的时间和成本，并可能被视为获得医疗服务的障碍，因为年轻人获得现金的机会可能较少，需求相互竞争，对时间的控制力也较差。关于针对年轻人口的综合干预措施的有效提供模式的数据有限，因此，本研究旨在确定在南非选定的设施实施一种为少女和年轻妇女（AGYW）性健康和生殖健康（SRH）提供服务的综合混合模式的可行性。综合服务提供模式将是一种混合模式，包括综合避孕、性传播感染/艾滋病毒传播预防和心理健康检查，并与艾滋病毒治疗、预防措施和社会心理支持等护理服务联系起来。保健方面的联系应促进与适当保健的联系。为了确定在选定的设施实施这种干预措施是否可行，本研究将采用4个要素，即可接受性、需求、实用性和适应性，并采用以下目标：(1)确定客户、供应商和关键信息提供者对为AGYW提供SRH服务的集成混合模型的接受程度；(2)评估AGYW对集成SRH服务的需求和偏好；(3)确定在资源受限的情况下为AGYW提供SRH服务的集成混合模型的实用性；(4)确定当前的集成水平以及为AGYW实施SRH服务交付集成混合模型所需的适应性。

Adolescent girls and young women (AGYW) experience significant health challenges including HIV infection, unwanted teenage pregnancies and sexually transmitted diseases in South Africa. Challenges exist with the uptake and utilization of sexual and reproductive health services for AGYW and there are a number of missed opportunities with the health system to provide prevention and care to AGYW. There is a renewed drive for service integration by policy makers to integrate SRH services with newly emerging HIV prevention and treatment services, in addition to scaling up access to prevention, care and treatment of STI's at a primary healthcare level. Current isolated service delivery models adds time and cost to clinic facilities and may be seen as a barrier to accessing care, as young people may have less access to cash, competing demands and less control over their time. There is limited data on effective delivery models for integrated interventions for young populations, therefore this study aims to determine the feasibility of implementing an integrated hybrid model of service delivery for adolescent girls and young women (AGYW) sexual and reproductive health (SRH) at selected facilities in South Africa. The integrated service delivery model will be a hybrid model comprising of both integration of contraceptive, STI/HIV transmission prevention and mental health screening with linkage to care services for HIV treatment, PrEP and psychosocial support. The linkages to appropriate care should be facilitated by health connectors. In order to determine whether such an intervention would be feasible to implement at selected facilities, this study will 4 elements, namely acceptability, demand, practicality and adaptation using the following objectives: (1) determine client, provider and key informant acceptability of the integrated hybrid model for SRH service delivery for AGYW, (2) assess demand and preference for integrated SRH services amongst AGYW, (3) determine the practicality of delivering integrated hybrid model for SRH service delivery for AGYW in a resource constrained setting, and (4) determine current level of integration and the adaptations needed to implement the integrated hybrid model for SRH service delivery for AGYW.