A conceptual framework for integrating HIV, STIs and pregnancy prevention services in Vhembe District, Limpopo, South Africa: improving teenagers' health outcomes.

backgroundAgainst the backdrop of increasing international calls for the development and implementation of integrated person-centered care that address both quality and access issues to improve adolescent and youth health services, this paper aims to develop a conceptual framework for integrating Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STIs) prevention into pregnancy prevention routine services in Vhembe District, to improve teenagers' health outcomes.

methodsA convergent triangulation mixed methods design was used for comparing and contrasting of quantitative and qualitative data to determine the extent of agreement between the two data types to generate contextual findings. In this study, employing both quantitative data were collected through questionnaires on a sample of healthcare workers (n = 112) providing Adolescent and Youth-Friendly Services to evaluate programme effectiveness on the high rate of teenage pregnancy and HIV infection among youth in Vhembe District. Qualitative data were collected using face-to-face interviews with nurses (n = 24) and teenagers aged 14-19 yrs (n = 28). For a richer understanding of dynamic family planning and HIV programs, face-to-face interview was conducted to explore more deeply the experiences and challenges of teenagers between the ages of 14-19 years. Nurses were interviewed on the barriers and facilitators of integrating HIV, STI and pregnancy prevention services in the rural facilities of Vhembe District. Quantitative data were analysed using frequencies and percentages, and qualitative data were analysed using thematic analysis.

resultsThe findings of the study point out that the integrated HIV, STIs and pregnancy prevention service uptake among adolescents is likely to be influenced by social and institutional factors. It is also evident from this study that adolescents face challenges when it comes to obtaining PrEP, PEP and contraceptives in primary healthcare clinics. Provider competency reveals a disparity, with a majority 67.0% of healthcare providers trained in effective communication with adolescents with 95% Confidence Interval of [0.57-0.75] (n = 112), suggesting a high level of adoption in the population. In comparison, significantly fewer have received specific training in AYFS 16% with 95% Confidence Interval of [0.09-0.24] (n = 112) or on Pre-Exposure Prophylaxis (PrEP) 25.9% with 95% Confidence Interval of [0.18-0.35] (n = 112), underscoring the need for a more balanced approach to training focus.

conclusionsThe empirical findings provide evidence on challenges unique to low-resource, rural settings, contributing to global discourse on HIV and Sexual Reproductive Health (SRH) integration. Consequently, 95% of the key stakeholders and experts approved the feasibility and applicability, while 92% approved the acceptability and sustainability of the proposed framework. It is recommended in this study that policy changes be implemented through an integrated health policy that recognizes the interconnectedness of HIV, STIs, and teenage pregnancy prevention to improve access to quality healthcare and education for youth.