Search

Background: The unmet need for safe and effective contraception still remains high. In 2017, about 25% of women of childbearing age who wanted to avoid pregnancy in the developing world were not using a modern contraceptive method. The biggest proportion (21%) of these women live in Sub-Saharan Africa. Little attention has been paid to the health systems factors impacting the integration of family planning into HIV services. This systematic review intends to document health systems factors constraining or facilitating the integration of family planning into HIV services., Methods: A search of electronic databases such as PubMed and Google Scholar was conducted using keywords. We considered peer-reviewed articles which were published in English between 1 st January 2010 and 31 st December 2020. The peer-reviewed articles which were considered focussed on identifying barriers and facilitators at the levels of the health system which influence the success or failure of integrated family planning and HIV programs, availability of integrated family planning services in HIV care, the evidence on the feasibility, effectiveness and cost-effectiveness of integrating family planning and HIV services and investigating the outcomes of programs aimed at strengthening family planning integration in HIV counselling, testing and care. Twenty-seven articles that identify factors affecting integration of family planning into HIV services met the inclusion criteria and were thematically analysed., Results: Health systems factors constraining integration of family planning and HIV services were human resource turnover and shortages, lack of policy guidance on integrated care, poor oversight, unclear service delivery guidelines, inadequate infrastructure and insufficient monitoring systems. Facilitators to the successful integration of family planning into HIV services were identified as training in family planning for service providers, the creation of a supportive policy environment to accommodate service integration, supportive supervision and a positive attitude by service providers towards service integration., Conclusion: Increase in the health workforce to support integrated service delivery, skills enhancement for service providers and improvement in family planning commodity stock levels play a key role in facilitating the integration of family planning into HIV services.

Zambia, like other low- and middle-income countries, faces numerous adolescent sexual and reproductive health challenges such as teenage pregnancies. This study aimed at understanding teachers' and community health workers' (CHWs) implementation of comprehensive sexuality education (CSE) as part of a comprehensive support package for adolescent girls to prevent early childbearing. Data collected using in-depth interviews [ n = 28] with teachers [ n = 15] and community health workers [ n = 13] were analysed using thematic analysis. The teachers and CHWs reported that the use of participatory approaches and collaboration between them in implementing CSE enabled them to increase girls' and boys' participation youth clubs. However, some teachers and CHWs experienced practical challenges with the manuals because some concepts were difficult to understand and translate into local language. The participants perceived that the youth club increased knowledge on CSE, assertiveness and self-esteem among the learners. Training and providing a detailed teaching manual with participatory approaches for delivering CSE, and collaborative teaching enabled teachers and CHWs to easily communicate sensitive SRH topics to the learners. However, for the adoption of CSE to be even more successful, piloting of the curriculum with local facilitators and translating the manuals into the local languages before they are implemented, is recommended.

Current law in Zambia criminalises same-sex sexual contact while strong socio-cultural values drive a profoundly negative view of the moral status of gender and sexual minorities. Despite this, Zambia's national HIV programme has recently identified the predominantly young population of men who have sex with men as a priority group for HIV and other sexual health programming. Research in other African settings has shown how the sexual health of these young men is affected by mental health. This mixed-methods study, which drew on the minority stress model as an analytical framework, sought to explore mental health as an initial step towards understanding its influence on other health domains. Findings describe the tension, and its psychological effects, surrounding the trajectory of discovering and affirming same-sex sexuality in an environment replete with social, physical and emotional risks, but one in which young men must nevertheless seek to create and maintain a meaningful, if precarious, social existence. To achieve this, in the absence of supportive mental health services or other programmatic responses, they adopt numerous risk-mitigation or coping strategies to attempt to build resiliency and to preserve their psychological and emotional well-being.

Zambia has one of the highest cervical cancer rates in the world. This paper explores the acceptability of the Human Papillomavirus vaccine administered in girls (9-13 years) in Zambia. A qualitative case study was conducted in two schools in Lusaka district, which participated in the pilot for the Human Papillomavirus vaccine rollout. The study revealed that community level health systems factors such as knowledge levels about the vaccine, sexual morality concerns, conflicting views from parents on the vaccine, rumours that the vaccine contained cervical cancer and that it causes infertility in girls, previous bad experience with other vaccines, religious beliefs such as belief that God protects against illness, the nature of the school environment as well as faith in doctors shaped the uptake of the vaccine. Furthermore, formal health system factors such as availability of health workers and nature of collaboration between the Ministries of Health and Education influenced acceptability of the vaccine among the girls. Strengthening collaboration between community and formal health systems can play a vital role in supporting uptake of vaccines at community level as factors that hinder uptake of the vaccines emanate from both the community and health sector.

Several health research organisations whose work focuses on international collaboration outline guidelines that support ethical practice in health research partnerships including building consensus around good collaborative research practice. This paper explores researcher's perspectives, experiences, and reflections on the elements of successful health research partnerships between Northern and Southern countries/institutions. The study adopted a qualitative research approach using in-depth interviews to explore what an authentic partnership is as experienced and aspired by stakeholders in health research partnerships in Zambia. Interviews were conducted with stakeholders implementing various health research activities in the country. Our findings revealed that Southern partners aspired for equal status and participation, transparency, and accountability, interdependency, and reciprocity, commitment to shared goals, open dialogue and sustainability in partnerships. While to some extent these aspirations overlap with the categories covered throughout the different partnership guidelines, some key aspects go beyond what is included in existing recommendations such as status and recognition which are salient in the broader guidelines. An important aspect in dismantling power structures that causes inequality in partnerships is through generating knowledge and innovation using local resources in the South to address local needs which can be subsequently re-used to address challenges at the global level.