The role ofadolescent-friendlyhealthservices in HIV preventionandgender-based violenceresponse amongadolescentgirlsandyoungwomen in Namibia


BACKGROUND: ACHIEVE Namibia, a USAID/PEPFAR-funded project, aims to achieve and sustain HIV epidemic control among adolescent girls and young women (AGYW) in northern Namibia. ACHIEVE builds on best practices in HIV prevention, sexual and reproductive health (SRH), and post-gender-based violence (GBV) care to strengthen adolescent-friendly health services (AFHS).
DESCRIPTION: ACHIEVE implemented DREAMS in four districts of two regions in Namibia from October 2020-September 2021 targeting AGYW aged 15-24 years old in 21 public health facilities. The DREAMS interventions include HIV prevention, GBV prevention and response, and SRH services, and are provided in adolescent-friendly clinics, DREAMS safe spaces in communities, and schools around the clinic. To address barriers to care, the clinics have clear signage, are staffed by AFHS-trained providers, actively engage AGYW, and offer a comprehensive service package under one roof. Clinics offer HIV testing services (HTS), pre-exposure prophylaxis (PrEP), linkage to antiretroviral therapy, sexually transmitted infection screening/treatment, counselling/provision of contraception, and post-GBV clinical care, amongst other services.
LESSONS LEARNED: The service provision has closed the gap of SRH/HIV and GBV prevention missed opportunities among AGYW. From October 2020-September 2021, 21,801 AGYW visited the clinics, of whom 98% (21,334) were assessed for HIV risk using a standard tool. The majority of them, 76% (16,278) were found at risk. Of those at risk, 71% (11,487) were tested, and 99% (11,374) tested negative. Among those who tested negative, 43% (4,929) were initiated on PrEP for the first time. Also, 4,090 received a modern contraceptive method, and 82% (1,187) of 1,441 reported GBV cases received post-GBV clinical care. The distribution of service provision by age group is in Figure 1.

CONCLUSIONS: Offering integrated AFHS approaches and addressing the barriers faced by AGYW in accessing high-quality HIV/SRH services contributes to increased service uptake, better care, and improved health outcomes (ex. preventing unintended pregnancies and HIV acquisition) among AGYW.