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. 2020 May 4;10(5):e033035.
doi: 10.1136/bmjopen-2019-033035.

Linkage of voluntary medical male circumcision clients to adolescent sexual and reproductive health (ASRH) services through Smart-LyncAges project in Zimbabwe: a cohort study

Talent M Makoni  1   2 , Pruthu Thekkur  3   4 , Kudakwashe C Takarinda  5 , Sinokuthemba Xaba  5 , Getrude Ncube  5 , Nonhlahla Zwangobani  5 , Julia Samuelson  6 , Aveneni Mangombe  5 , Simbarashe Mabaya  2 , Talent Tapera  5 , Ronald Matambo  7 , Wole Ameyan  6 , Owen Mugurungi  5
Affiliations

Linkage of voluntary medical male circumcision clients to adolescent sexual and reproductive health (ASRH) services through Smart-LyncAges project in Zimbabwe: a cohort study

Talent M Makoni et al. BMJ Open. .

Abstract

Objectives: WHO recommended strengthening the linkages between various HIV prevention programmes and adolescent sexual reproductive health (ASRH) services. The Smart-LyncAges project piloted in Bulawayo city and Mt Darwin district of Zimbabwe established a referral system to link the voluntary medical male circumcision (VMMC) clients to ASRH services provided at youth centres. Since its inception in 2016, there has been no assessment of the performance of the referral system. Thus, we aimed to assess the proportion of young (10-24 years) VMMC clients getting 'successfully linked' to ASRH services and factors associated with 'not being linked'.

Design: This was a cohort study using routinely collected secondary data.

Setting: All three VMMC clinics of Mt Darwin district and Bulawayo province.

Primary outcome measures: The proportion of 'successfully linked' was summarised as the percentage with a 95% CI. Adjusted relative risks (aRR) using a generalised linear model was calculated as a measure of association between client characteristics and 'not being linked'.

Results: Of 1773 young people registered for VMMC services, 1478 (83%) were referred for ASRH services as they had not registered for ASRH previously. Of those referred for ASRH services, the mean (SD) age of study participants was 13.7 (4.3) years and 427 (28.9%) were out of school. Of the referred, 463 (31.3%, 95% CI: 30.0 to 33.8) were 'successfully linked' to ASRH services and the median (IQR) duration for linkage was 6 (0-56) days. On adjusted analysis, receiving referral from Bulawayo circumcision clinic (aRR: 1.5 (95% CI: 1.3 to 1.7)) and undergoing circumcision at outreach sites (aRR: 1.2 (95% CI: 1.1 to 1.3)) were associated with 'not being linked' to ASRH services.

Conclusion: Linkage to ASRH services from VMMC is feasible as one-third VMMC clients were successfully linked. However, there is need to explore reasons for not accessing ASRH services and take corrective actions to improve the linkages.

Keywords: HIV & AIDS; adolescent health; operational research; sexual and reproductive health; sort it; youth centres.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow-chart depicting the adolescents eligible for referral to ASRH services, circumcision status and linkage to ASRH services among those registered at selected VMMC clinics of Zimbabwe during October to November 2018. ASRH, adolescent sexual reproductive health; VMMC, voluntary medical male circumcision.
See this image and copyright information in PMC

References

    1. Joint United Nations Programme on HIV/AIDS (UNAIDS) Youth and HIV — Mainstreaming a three-lens approach to youth participation. Geneva, Switzerland, 2018.
    1. Joint United Nations Programme on HIV/AIDS (UNAIDS) Start free, stay free, AIDS free. Geneva, Switzerland, 2015.
    1. UNICEF Adolescent deaths from AIDS tripled since 2000 – UNICEF | press centre | UNICEF. Available: https://www.unicef.org/media/media_86384.html [Accessed 8 May 2019].
    1. World Health Organization (WHO) WHO | adolescent deaths and burden of disease, 2017. Available: https://www.who.int/maternal_child_adolescent/epidemiology/adolescent-de... [Accessed 8 May 2019].
    1. UNICEF END AIDS seventh stocktaking report, 2016. New York, USA, 2016.

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