Best Practices for Adolescent- and Youth-Friendly HIV Services

Jul 13, 2017

Adolescents and youth (ages 10-24) bear a disproportionate burden of HIV infection, especially in sub-Saharan Africa. Evidence of what works to attract and retain youth in preventive care for the uninfected and treatment for those already infected is sorely needed for designing and implementing effective programs.

MEASURE Evaluation, funded by the U.S. Agency for International Development (USAID), and in service of the 90-90-90[1] goals, recently published findings of a review of youth-oriented HIV programs with the objective to uncover proven and promising practices and make them available to the global community. Projects were identified through a global call and a peer-reviewed literature search and were graded by a review group using well-established criteria. This evidence is contained in two documents: Guidelines on Best Practices for Adolescent- and Youth-Friendly HIV Services[2] and Best Practices for Adolescent- and Youth-Friendly HIV Services.[3] 

These two volumes document seven best practices, four promising practices, and two emerging practices. Those projects identified as exemplifying best practices are (1) Adolescent-friendly Voluntary Medical Male Circumcision Project, in South Africa; (2) Futbol para la Vida (Deportes para la Vida), in Dominican Republic; (3) MEMA kwa Vijana, in the United Republic of Tanzania, (4) One2one Integrated Digital Platform, in Kenya; (5) Supporting Youth and Motivating Positive Action (SYMPA), in the Democratic Republic of the Congo; (6) Program H, in Ethiopia and Namibia; and (7) Zvandiri Programme, in Zimbabwe.

Researchers identified several ways all of these programs attracted youth, which can offer guidance for others:

  • It's important to engage youth in program design and implementation.
  • Services for youth should be offered after school and delivered in centers run by trained adolescents or in mobile testing centers that youth can easily access.
  • Services and commodities such as condoms should be affordable or free.
  • Services should be linked with schools, youth clubs, and other youth-friendly venues.
  • Counseling, information, and services should be offered through mobile or web platforms.
  • Staff should be well-trained, including in ways to work with youth and to safeguard privacy and confidentiality.
  • Peer counseling should be offered on risk reduction, safer sex, voluntary counseling and testing for HIV, and adherence to antiretroviral drugs.

Researchers also compiled several lessons that can be applied to future program design. These were:

  • Adapt information materials and learning activities to the level of education among the participants, which can vary.
  • Mobile testing or testing in churches, markets, or community centers will reach more youth than clinic testing where youth-oriented clinic services are scarce.
  • Anonymity makes it easier for adolescents and youth to ask questions and seek advice, which is an advantage of mobile- and web-based services.
  • A school-based curriculum will require more than a single training to impart understanding on how to deal with psychosocial issues among adolescents.
  • Involvement from community residents and organizations is crucial for success of improving HIV-related knowledge and attitudes among adolescents and youth. This involvement can be hard to build. Some tactics are: stakeholder buy-in, building community coalitions supportive of youth, community participation in implementing the program, recruiting community leaders as advocates, and creating partnerships with local organizations.
  • Adolescents and youth living with HIV will need individualized transition to adult care programs.

"We need to disseminate this type of research so that others can implement youth-friendly services that can prevent new infections and ensure HIV positive youth live long and healthy lives," says MEASURE Evaluation's Eva Silvestre, PhD, research assistant professor at Tulane University. "We also need to continue to promote high-quality monitoring and impact evaluation of existing programs to identify other effective programs for youth."

For more information

MEASURE Evaluation strengthens capacity in developing countries to gather, interpret, and use data to improve health. The project provides critical data for HIV program managers and decision makers to effectively design and target their programs.

[1] United Nations Joint Programme on HIV/AIDS (UNAIDS). 2017. The goal is that 90 percent of people will know their HIV status, that 90 percent of those testing positive will enroll in care, and that 90 percent of those who are HIV-positive will have suppressed viral loads. See

[2] Anastasia J. Gage, Mai Do, and Donald Grant. 2017. Guidelines on Best Practices for Adolescent- and Youth-Friendly HIV Services-An Examination of 13 Projects in PEPFAR-Supported Countries. Chapel Hill, NC: University of North Carolina at Chapel Hill, MEASURE Evaluation.

[3] Anastasia J. Gage, Mai Do, and Donald Grant. 2017. Best Practices for Adolescent- and Youth-Friendly HIV Services-A Compendium of Selected Projects in PEPFAR-Supported Countries. Chapel Hill, NC: University of North Carolina at Chapel Hill, MEASURE Evaluation.


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