Adolescent Wellness Visits in Tanzania Getting adolescents in the door of a health facility is an entrenched health system problem, particularly for HIV and sexual and reproductive health (SRH) services. Adolescents in low-resource settings need a preventative health service platform applicable for all young people that promotes a culture of health-seeking behavior. In response to PAR- impact of Adolescent Wellness Visits (AWVs), a 19-274 [Dissemination & Implementation Research in Health], this R01 will evaluate the new health service platform, for reaching young adolescents with HTC and other evidence-based prevention services which are clinic-based and school-facilitated. We posit that by coupling sexual and reproductive health (SRH) and non-SRH information and services, issues of self- risk assessment, and access to services may be circumvented. AWVs could meet the SRH needs of at-risk adolescents, and have a larger public health impact for all adolescents on access to traditionally neglected and untreated non-SRH issues such as poor nutrition, vision, dental, and mental health problems at the time of delivery as well as in the future as adolescents continue with more timely service utilization. The AWV is designed to be delivered during the last year of primary school when school attendance is high and adolescents are on the cusp of puberty (mean age 13). This project is a collaboration between Duke University and Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania.
Specific Aims are: 1) To assess the impact of the Adolescent Wellness Visit model on HTC (primary outcome for all adolescents) and contraceptive uptake (secondary outcome for sexually active adolescents) up to two years post-primary school via a cluster randomized controlled trial (24 school-clinic pairs: 12 intervention + 12 control; n=552 adolescents); 2) To evaluate factors that support or limit implementation of the AWV model and fidelity/adherence to implementation of the proposed package of evidence-based practices included in the AWV; and 3) To determine the cost-effectiveness of the AWV model for increased HIV testing, reaching PEPFAR diagnostic targets, and reductions in unmet need for contraception. This D&I proposal creates and leverages a new population level health service for adolescents that aligns with NICHD?s Research Theme #5: Improving Health during the Transition from Adolescence to Adulthood (NOT-HD-18-031), and as a nurse- delivered intervention, it also aligns with NINR?s strategic focus area?Wellness: Promoting Health and Preventing Illness (16-NR-778). A prevention-focused adolescent health service in LMICs can set the tone for a ?culture of health and wellness? during this critical developmental period.
Adolescent Wellness Visits in Tanzania: Bundling evidence-based prevention services to increase uptake of HIV Testing and Counseling and other health services Adolescents are less likely to access prevention-oriented health services such as HIV testing and counseling (HTC) and contraception than adults, yet young people bear a disproportion burden of poor HIV and reproductive health outcomes in many low-resource settings. This study evaluates a new service delivery platform for reaching adolescents in Tanzania with HTC and other evidence-based screening services via clinic-based ?Adolescent Wellness Visits? coordinated between primary schools and health facilities that offer a package of youth-friendly services. We posit that by coupling sexual and reproductive health (SRH) services with non- SRH services such as nutrition, vision, dental and mental health screenings, applicable for all adolescents, adolescent health service use including HTC will increase and a tone will be set for a ?culture of health and wellness? during this critical developmental period.
