New and innovative strategies are urgently needed to increase the uptake of HIV prevention and sexual and reproductive health services among adolescent girls and young women (AGYW) in sub-Saharan Africa. In this study, we will develop and pilot an intervention to create AGYW-friendly drug shops in Tanzania where we will distribute HIV self-test kits alongside contraception and linkages to care. The results from the study will provide guidance about whether community-based distribution of HIV testing at drug shops is an effective strategy for decreasing the incidence of HIV and unintended pregnancies among AGYW.
Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa (SSA) face the dual threats of HIV infection and unintended pregnancy that severely undermine their long-term wellbeing. However, despite the urgent need to reach AGYW with sexual and reproductive health (SRH) services, health systems are often ill equipped to overcome the numerous barriers to health care services faced by AGYW. The goal of the proposed study is to develop and pilot an intervention in Tanzania to develop AGYW-friendly drug shops as a venue where AGYW can access HIV prevention services and contraception. The motivation for this approach is the growing recognition that drug shops, which are widely distributed, can promote beneficial health behaviors, bridge gaps in health services, and mitigate health workforce shortages. Furthermore, HIV testing is the gateway to HIV prevention and care services, and self-testing with oral fluid has been recently recommended by the World Health Organization (WHO) although it has not been widely adopted. We hypothesize that creative strategies led by drug shop owners (e.g., sales of AGYW-relevant products, creation of an AGYW-welcoming environment) can attract AGYW and will bolster uptake of SRH services, including HIV self-test (HIVST) kits and contraception. We will first develop and operationalize intervention elements predicated on theoretical constructs from behavioral economics that are appropriate and effective for motivating AGYW to seek SRH services at drug shops, including HIVST kits (Aim 1). To achieve this, we will use human-centered design methods, a creative and empathetic intervention design approach adapted from the private sector marketing industry. We will then conduct a pilot study of the final intervention at 20 drug shops to determine whether the intervention is successful at encouraging AGYW to visit drug shops and obtain HIVST kits and contraception (Aim 2). A mixed-methods process evaluation (Aim 3) will determine whether the intervention is acceptable and feasible and whether a future effectiveness and sustainability study on the primary outcomes of uptake of HIV prevention services and linkage to care is warranted. The research team is a collaboration between the University of California (San Francisco and Berkeley), Health for a Prosperous Nation, and the Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children. The proposed study will explore, for the first time, whether AGYW-friendly drug shops can be used to distribute HIV prevention and SRH services to AGYW. The study will also be one of the first studies of HIVST in Tanzania. The results will provide guidance about the acceptability of HIVST and whether this community- based platform of distribution via drug shops is feasible, acceptable, and worthy of future development for its potential to reach at-risk and HIV-infected AGYW and reduce unmet need for contraception for them.