The Impact of an Integrated Adolescent Youth Centre and Clinic on Sexual Reproductive Healthcare Utilisation and HIV Testing in the Western Cape
Despite the increasing HIV incidence among young South African women, HIV counseling and testing (HCT) rates remain unacceptably low. One in three young women has a pregnancy by the age of 20. Alternative strategies should be explored in order to increase prevention and screening among high-risk adolescents.
Methods: The Desmond Tutu HIV Foundation (DTHF) Youth Centre (YC) in Masiphumelele, Cape Town, offers integrated health, educational and recreational programmes in order to increase adolescent access to comprehensive sexual and reproductive health services (SRH). Participation is incentivised and clinic statistics tracked with a biometric data system. We compared HIV testing and contraception rates with data from a public clinic in Imizamo Yethu (IY), Cape Town, a community with similar demographics, to ascertain the impact of the YC on SRH and HCT utilisation rates for adolescents.
Results: In 2015, adolescent females under 18 had 3.74 times (3.37-4.15) more contraception visits at the YC than adolescents at IY clinic. There was no difference in the type of contraception used, with both populations favouring injectable methods. Adherence to contraception was sub-optimal, with the average YC female using contraception for 6.1 months/year. Youth at the YC were 1.85 times more likely to have HCT than youth in IY. This difference was greater in boys, with those aged between 15-24 3.83 times (3.04-4.81) are more likely to test. YC attendees were a third less likely to test HIV positive than their IY counterparts. Female sex, older age, clinic attendance for contraception and STI treatment, redeeming incentive points for rewards, and high Youth Centre attendance were all independent factors associated with increased HIV testing.
Interpretation: Adolescents from Masiphumelele were significantly more likely to access SRH and HCT services at the YC in comparison to the public clinic in Imizamo Yethu that has made adolescent friendly accommodations. The differences were most dramatic in contraception coverage for females under 18 and HIV testing rates in males. Lessons from the DTHF YC may be applied to clinics in order to increase adolescent health care utilisation rates.