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Uptake of HIV testing among adolescents and associated adolescent-friendly services

AUTHOR(S)
Jennifer Waidler, Rachel Kidman, Tia Palermo

Published: 2020

HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact. The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents’ uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services.

Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexuallyactive adolescents.

We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence.

Multidimensional Poverty Among Adolescents in 38 Countries: Evidence from the Health Behaviour in School-aged Children (HBSC) 2013/14 Study

AUTHOR(S)
Yekaterina Chzhen, Zlata Bruckauf, Emilia Toczydlowska, Frank Elgar, Conception Moreno-Maldonado, Gonneke W.J.M. Stevens, Dagmar Sigmudova, Geneviève Gariépy

Published: 2017
This study applied UNICEF’s Multiple Overlapping Deprivation Analysis (MODA) framework to adolescents (aged 11, 13 and 15) in 37 European countries and Canada using data from the 2013/14 Health Behaviour in School-aged Children survey. It is one of the first applications of MODA based entirely on data collected from adolescents themselves rather than from household reference persons on their behalf. Unlike most other multidimensional child poverty studies, the present analysis focuses on non-material, relational aspects of child poverty. Substantial cross-country variation was found in the prevalence of adolescent deprivations in nutrition, perceived health, school environment, protection from peer violence, family environment and information access. These single dimensions of poverty did not closely relate to national wealth and income inequality. However, when we looked at deprivation in three or more dimensions (i.e., multidimensional poverty), we found association with income inequality. In most countries, girls were at a higher risk of multidimensional poverty than boys. In addition, adolescents who lived with both parents in the household or reported higher family wealth were consistently less poor than other adolescents, in both single and multiple dimensions. The results of this study show the interconnectedness of social (family, school support) and psychological (health and violence) dimensions of poverty for adolescents in higher income countries. Children poor in the domains of family and school environment are also likely to be poor in terms of perceived health and protection from peer violence.
Physical, Emotional and Sexual Adolescent Abuse Victimisation in South Africa: Prevalence, incidence, perpetrators and locations

AUTHOR(S)
F. Meinck, F. Cluver, M. Boyes, Heidi Loening-Voysey

Published: 2016

Background Physical, emotional and sexual abuse of children is a major problem in South Africa, with severe negative outcomes for survivors. To date, no known studies have used data directly obtained from community-based samples of children to investigate prevalence, incidence, locations and perpetrators of child abuse victimisation. This study aims to investigate prevalence and incidence, perpetrators, and locations of child abuse victimisation in South Africa using a multicommunity sample.

Methods 3515 children aged 10–17 years (56.6% female) were interviewed from all households in randomly selected census enumeration areas in two South African provinces. Child self-report questionnaires were completed at baseline and at 1-year follow-up (96.7% retention).

Results Prevalence was 56.3% for lifetime physical abuse (18.2% past-year incidence), 35.5% for lifetime emotional abuse (12.1% incidence) and 9% for lifetime sexual abuse (5.3% incidence). 68.9% of children reported any type of lifetime victimisation and 27.1% reported lifetime multiple abuse victimisation. Main perpetrators of abuse were reported: for physical abuse, primary caregivers and teachers; for emotional abuse, primary caregivers and relatives; and for sexual abuse, girlfriend/boyfriends or other peers.

Conclusions This is the first study assessing current self-reported child abuse through a large, community-based sample in South Africa. Findings of high rates of physical, emotional and sexual abuse demonstrate the need for targeted and effective interventions to prevent incidence and re-victimisation.

Effects of a Large-scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya: A cluster randomized trial

AUTHOR(S)
Kelly Kilburn, Harsha Thirumurthy, Carolyn Tucker Halpern, Audrey Pettifor, Sudhanshu Handa

Published: 2016

Purpose

This study investigates the causal effect of Kenya's unconditional cash transfer program on mental health outcomes of young people.

Methods

Selected locations in Kenya were randomly assigned to receive unconditional cash transfers in the first phase of Kenya's Cash Transfer Program for orphans and Vulnerable Children. In intervention locations, low-income households and those with orphans and vulnerable childrens began receiving monthly cash transfers of $20 in 2007. In 2011, 4 years after program onset, data were collected on the psychosocial status for youth aged 15–24 years from households in intervention and control locations (N = 1960). The primary outcome variable was an indicator of depressive symptoms using the 10-question Center for Epidemiologic Studies Depression Scale. Secondary outcomes include an indicator for hopefulness and physical health measures. Logistic regression models that adjusted for individual and household characteristics were used to determine the effect of the cash transfer program.

Results

The cash transfer reduced the odds of depressive symptoms by 24 percent among young persons living in households that received cash transfers. Further analysis by gender and age revealed that the effects were only significant for young men and were larger among men aged 20–24 years and orphans.

Conclusions

This study provides evidence that poverty-targeted unconditional cash transfer programs, can improve the mental health of young people in low-income countries.

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