Reaching Youth with Out-of-Facility HIV and Reproductive Health Services: A Systematic Review

This systematic literature review was undertaken to identify policies promoting or programmes delivering HIV or reproductive health services to adolescents in their communities. The researchers reviewed studies that evaluated uptake of services or commodities. Data from studies meeting inclusion criteria were qualitatively analysed.

Literature from databases: PubMed, EMBASE, Popline, CINAHL, and all the World Health Organization (WHO) regional was analysed, as well as gray literature searched on Google. Some inclusion criteria included:

• at least half of the population studied was aged 10-24 years;
• the interventions were either :

1. policies promoting or mandating HIV or reproductive health services (including sexually transmitted infections (STI), HIV, or pregnancy testing) or commodities (including condoms, contraceptives, emergency contraception clean needles, and syringes or exchanges); or
2. programmes or projects providing these services;

• randomised controlled trials, quasi-experimental studies, and observational studies with a control group or time series analyses were of primary interest;
• intervention delivery took place outside of health facilities, including in pharmacies, in jails and detention centres, on the street, in parks, or in community centres; and
• outcomes included measures related to use of HIV or reproductive health services or receipt of or use of related commodities, among others.

In its summary, the study concludes: "The studies we reviewed demonstrate generally positive uptake of health services via out-of-facility-based approaches, although results did vary across settings and approaches. The most successful approaches included mail-based STI screening and condom distribution via street outreach in developed country settings, home-based HIV counseling and testing in a rural developing country setting, and policies allowing (in several developed countries) and a program promoting (in an urban developing country setting) pharmacy over-the-counter-based access to EC [emergency contraception]. Overall, the studies suggest that out-of-facility approaches can be important avenues to reach marginalized youth. Rigorous implementation research is needed to assess the true impact that such strategies can have. This is perhaps especially true in developing settings because their youth carry the greatest burden of disease, disability, and mortality relative to the rest of the world. Costing determinations and cost-benefit analyses are needed in the face of limited resources for health services. Determining ways to effectively reach adolescents and young adults with HIV and reproductive health services is crucial in reducing not only youth morbidity and mortality but also in mitigating adult disease burden."