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Background: Combination prevention interventions, when integrated with community-based support, have been shown to be particularly beneficial to adolescent and young peoples' sexual and reproductive health. Between 2020 and 2022, the Africa Health Research Institute in rural South Africa conducted a 2 × 2 randomised factorial trial among young people aged 16–29 years old (Isisekelo Sempilo) to evaluate whether integrated HIV and sexual and reproductive health (HIV/SRH) with or without peer support will optimise delivery of HIV prevention and care. Using mixed methods, we conducted a process evaluation to provide insights to and describe the implementation of a community-based peer-led HIV care and prevention intervention targeting adolescents and young people. Methods: The process evaluation was conducted in accordance with the Medical Research Council guidelines using quantitative and qualitative approaches. Self-completed surveys and clinic and programmatic data were used to quantify the uptake of each component of the intervention and to understand intervention fidelity and reach. In-depth individual interviews were used to understand intervention experiences. Baseline sociodemographic factors were summarised for each trial arm, and proportions of participants who accepted and actively engaged in various components of the intervention as well as those who successfully linked to care were calculated. Qualitative data were thematically analysed. Results: The intervention was feasible and acceptable to young people and intervention implementing teams. In particular, the STI testing and SRH components of the intervention were popular. The main challenges with the peer support implementation were due to fidelity, mainly because of the COVID-19 pandemic. The study found that it was important to incorporate familial support into interventions for young people's sexual health. Moreover, it was found that psychological and social support was an essential component to combination HIV prevention packages for young people. Conclusion: The results demonstrated that peer-led community-based care that integrates SRH services with HIV is a versatile model to decentralise health and social care. The family could be a platform to target restrictive gender and sexual norms, by challenging not only attitudes and behaviours related to gender among young people but also the gendered structures that surround them. [ABSTRACT FROM AUTHOR]

In a setting where substance use is rife, understanding contextual factors that influence an individual's perceived eligibility to seek rehabilitation is paramount. The study explores how situational factors influence an individual's perceived eligibility for healthcare uptake in people with substance use disorder (SUD). Using qualitative methods, the study draws on in-depth interviews with 20 substance users and 20 family members to unpack how individuals with SUD negotiate their eligibility for health services. Findings show that substance users are aware of their substance use habits and acknowledge their eligibility for health services with information on the navigation of health services is shared by peers and family members. Access and use of health services is hindered by individual determinants and the availability of health services for substance users, such as rehabilitation centers. The hunt for drugs and long waiting queues for health service acquisition overshadows substance users' claim to health services. Future research should prioritize understanding substance use and health seeking behavior at a context specific level in community settings so that, even in the absence of substance use health facilities, substance use is addressed at least from a harm reduction perspective which can improve health outcomes. [ABSTRACT FROM AUTHOR]

Background: The World Health Organisation (WHO) realizes that key shifts are required to end STIs as a public concern by 2030. 'New' models of sexual and reproductive health (SRH) services need to be adapted to social contexts to respond to current and future threats. This paper describes the acceptability, feasibility, and experiences of a peer-led intervention to deliver biosocial SRH and HIV prevention for adolescents and youth in rural KwaZulu-Natal, South Africa. Methods: The Thetha Nami (Talk to me) intervention included peer support for health promotion and facilitated linkage to adolescent and youth-friendly services (AYFS) for SRH HIV care and prevention. Between 2019-2021 we embedded a process evaluation into a randomized controlled trial of the effectiveness of Thetha Nami for HIV prevention. We used the MRC process evaluation framework to collect and analyse both quantitative and qualitative data. Qualitative data explored experiences, perceptions, and contextual influences from the intervention, and survey data captured in REDCAP software determine intervention dose and reach. A total of 91 interviews were conducted with young people from both arms, clinical staff, refusals, peer navigators, and research assistants. Qualitative data were thematically analysed, and quantitative data were descriptively analysed. Results: A total of 779 participants were randomized to peer support, of which 734 participants were contacted. Quantitative process data shows that 675 (87%) of those randomized to peer support received support over two years. A total of 8218 visits were made, with participants being visited between 1 to 25 times. Findings demonstrate that peer-to-peer psychosocial support is acceptable to adolescents and youth. The service users felt that peers were able to deliver health promotion, including sexual and reproductive health, and could refer young people to the AYFS. However, peers felt less able to provide social, educational, and legal support. Findings demonstrated a need for improved social assistance. COVID-19 lockdowns between March 2020 and 2021 resulted in a shift from face-to-face contact to virtual support, impacting intervention delivery. Conclusion: Peer-to-peer biosocial interventions can effectively mobilize young people for HIV and SRH. However, resources for psychosocial support also need to be included in the package. [ABSTRACT FROM AUTHOR]