“They call me the ‘Great Queen’”: implementing the Malkia Klabu program to improve access to HIV self-testing and contraception for adolescent girls and young women in Tanzania
Abstract Background Adolescent girls and young woman (AGYW) comprise a significant proportion of new HIV infections and unintended pregnancies in sub-Saharan Africa yet face many barriers to accessing family planning and reproductive health (FPRH) information and services. Developed via human-center...
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | Reproductive Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12978-024-01744-x |
| _version_ | 1797274479524577280 |
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| author | Rachel Willard-Grace F. Abigail Cabrera Camilla Bykhovsky Kayla Douglas Lauren A. Hunter Agatha Mnyippembe Kassim Hassan Mgunya Sandra I. McCoy Jenny X. Liu |
| author_facet | Rachel Willard-Grace F. Abigail Cabrera Camilla Bykhovsky Kayla Douglas Lauren A. Hunter Agatha Mnyippembe Kassim Hassan Mgunya Sandra I. McCoy Jenny X. Liu |
| author_sort | Rachel Willard-Grace |
| collection | DOAJ |
| description | Abstract Background Adolescent girls and young woman (AGYW) comprise a significant proportion of new HIV infections and unintended pregnancies in sub-Saharan Africa yet face many barriers to accessing family planning and reproductive health (FPRH) information and services. Developed via human-centered design, the Malkia Klabu (“Queen Club”) program aimed to facilitate access to HIV self-testing (HIVST) and FPRH information and products at privately-owned drug shops. We sought to understand barriers and facilitators to program implementation in a 4-month pilot in Tanzania. Methods Forty semi-structured interviews were conducted with participants in a cluster randomized trial of the Malkia Klabu program from November 2019 through March 2020, including 11 with AGYW, 26 with drug shopkeepers, and three with counselors at health facilities to whom AGYW were referred. Interviews were audio-recorded, transcribed, coded, and analyzed to identify key themes. The Consolidated Framework for Implementation Research (CFIR) was used to assess barriers and facilitators to program implementation at multiple levels. CFIR considers the outer setting (e.g., culture and systemic conditions), the inner setting where the intervention is implemented (e.g., incentives, relationships, and available resources), the individuals involved, the innovation as it relates to stakeholder needs, and the implementation process. Results The Malkia Klabu program reshaped and directed the role of drug shopkeepers as providers of information and resources rather than FPRH gatekeepers. Key implementation facilitators included the program’s adaptability to a wide range of needs and stages of readiness among AGYW, ability to capitalize on AGYW social networks for driving membership, responsiveness to AGYW’s need for privacy, and positive contributions to the income and community standing of drug shopkeepers. Components such as HIVST were highly acceptable to both AGYW and shopkeepers, and the introduction of the loyalty program and HIVST kits in shops opened doors to the provision of FPRH products and information, which was further facilitated by program tools such as videos, product displays, and symbol cards. Although some shopkeepers maintained beliefs that certain contraceptive methods were inappropriate for AGYW, most appeared to provide the products as part of the program. Conclusions The Malkia Klabu intervention's success was due in part to its ability to address key motivations of both AGYW and drug shopkeepers, such as maintaining privacy and increasing access to FPRH products for AGYW and increasing business for shops. Better understanding these implementation barriers and facilitators can inform the program’s future adaptation and scale-up. Trial registration: clinicaltrials.gov #NCT04045912. |
| first_indexed | 2024-03-07T14:58:58Z |
| format | Article |
| id | doaj.art-ec009adeba474457b361dfee9d243663 |
| institution | Directory Open Access Journal |
| issn | 1742-4755 |
| language | English |
| last_indexed | 2024-03-07T14:58:58Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Reproductive Health |
| spelling | doaj.art-ec009adeba474457b361dfee9d2436632024-03-05T19:18:28ZengBMCReproductive Health1742-47552024-02-0121111310.1186/s12978-024-01744-x“They call me the ‘Great Queen’”: implementing the Malkia Klabu program to improve access to HIV self-testing and contraception for adolescent girls and young women in TanzaniaRachel Willard-Grace0F. Abigail Cabrera1Camilla Bykhovsky2Kayla Douglas3Lauren A. Hunter4Agatha Mnyippembe5Kassim Hassan Mgunya6Sandra I. McCoy7Jenny X. Liu8Center for Excellence in Primary Care, University of California, San FranciscoCenter for Excellence in Primary Care, University of California, San FranciscoCenter for Excellence in Primary Care, University of California, San FranciscoCenter for Excellence in Primary Care, University of California, San FranciscoSchool of Public Health, University of California, BerkeleyHealth for a Prosperous NationHealth for a Prosperous NationSchool of Public Health, University of California, BerkeleyInstitute for Health and Aging, Bixby Center for Global Reproductive Health, University of California, San FranciscoAbstract Background Adolescent girls and young woman (AGYW) comprise a significant proportion of new HIV infections and unintended pregnancies in sub-Saharan Africa yet face many barriers to accessing family planning and reproductive health (FPRH) information and services. Developed via human-centered design, the Malkia Klabu (“Queen Club”) program aimed to facilitate access to HIV self-testing (HIVST) and FPRH information and products at privately-owned drug shops. We sought to understand barriers and facilitators to program implementation in a 4-month pilot in Tanzania. Methods Forty semi-structured interviews were conducted with participants in a cluster randomized trial of the Malkia Klabu program from November 2019 through March 2020, including 11 with AGYW, 26 with drug shopkeepers, and three with counselors at health facilities to whom AGYW were referred. Interviews were audio-recorded, transcribed, coded, and analyzed to identify key themes. The Consolidated Framework for Implementation Research (CFIR) was used to assess barriers and facilitators to program implementation at multiple levels. CFIR considers the outer setting (e.g., culture and systemic conditions), the inner setting where the intervention is implemented (e.g., incentives, relationships, and available resources), the individuals involved, the innovation as it relates to stakeholder needs, and the implementation process. Results The Malkia Klabu program reshaped and directed the role of drug shopkeepers as providers of information and resources rather than FPRH gatekeepers. Key implementation facilitators included the program’s adaptability to a wide range of needs and stages of readiness among AGYW, ability to capitalize on AGYW social networks for driving membership, responsiveness to AGYW’s need for privacy, and positive contributions to the income and community standing of drug shopkeepers. Components such as HIVST were highly acceptable to both AGYW and shopkeepers, and the introduction of the loyalty program and HIVST kits in shops opened doors to the provision of FPRH products and information, which was further facilitated by program tools such as videos, product displays, and symbol cards. Although some shopkeepers maintained beliefs that certain contraceptive methods were inappropriate for AGYW, most appeared to provide the products as part of the program. Conclusions The Malkia Klabu intervention's success was due in part to its ability to address key motivations of both AGYW and drug shopkeepers, such as maintaining privacy and increasing access to FPRH products for AGYW and increasing business for shops. Better understanding these implementation barriers and facilitators can inform the program’s future adaptation and scale-up. Trial registration: clinicaltrials.gov #NCT04045912.https://doi.org/10.1186/s12978-024-01744-xHIV self-testingDrug shopsAdolescent healthContraceptive methodsPrivate sector distributionTanzania |
| spellingShingle | Rachel Willard-Grace F. Abigail Cabrera Camilla Bykhovsky Kayla Douglas Lauren A. Hunter Agatha Mnyippembe Kassim Hassan Mgunya Sandra I. McCoy Jenny X. Liu “They call me the ‘Great Queen’”: implementing the Malkia Klabu program to improve access to HIV self-testing and contraception for adolescent girls and young women in Tanzania Reproductive Health HIV self-testing Drug shops Adolescent health Contraceptive methods Private sector distribution Tanzania |
| title | “They call me the ‘Great Queen’”: implementing the Malkia Klabu program to improve access to HIV self-testing and contraception for adolescent girls and young women in Tanzania |
| title_full | “They call me the ‘Great Queen’”: implementing the Malkia Klabu program to improve access to HIV self-testing and contraception for adolescent girls and young women in Tanzania |
| title_fullStr | “They call me the ‘Great Queen’”: implementing the Malkia Klabu program to improve access to HIV self-testing and contraception for adolescent girls and young women in Tanzania |
| title_full_unstemmed | “They call me the ‘Great Queen’”: implementing the Malkia Klabu program to improve access to HIV self-testing and contraception for adolescent girls and young women in Tanzania |
| title_short | “They call me the ‘Great Queen’”: implementing the Malkia Klabu program to improve access to HIV self-testing and contraception for adolescent girls and young women in Tanzania |
| title_sort | they call me the great queen implementing the malkia klabu program to improve access to hiv self testing and contraception for adolescent girls and young women in tanzania |
| topic | HIV self-testing Drug shops Adolescent health Contraceptive methods Private sector distribution Tanzania |
| url | https://doi.org/10.1186/s12978-024-01744-x |
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