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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]