Adolescent Wellness Visits in Tanzania

PROJECT ABSTRACT
Adolescent Wellness Visits in Tanzania
Getting adolescents in the door of a health facility is an entrenched health system problem, particularly for HIV
and sexual and reproductive health (SRH) services. Adolescents in low-resource settings need a preventative
health service platform applicable for all young people that promotes a culture of health-seeking behavior. In
response to PAR-
impact of Adolescent Wellness Visits (AWVs), a
19-274 [Dissemination & Implementation Research in Health], this R01 will evaluate the
new health service platform, for reaching young adolescents
with HTC and other evidence-based prevention services which are clinic-based and school-facilitated. We posit
that by coupling sexual and reproductive health (SRH) and non-SRH information and services, issues of self-
risk assessment, and access to services may be circumvented. AWVs could meet the SRH needs of at-risk
adolescents, and have a larger public health impact for all adolescents on access to traditionally neglected and
untreated non-SRH issues such as poor nutrition, vision, dental, and mental health problems at the time of
delivery as well as in the future as adolescents continue with more timely service utilization. The AWV is
designed to be delivered during the last year of primary school when school attendance is high and
adolescents are on the cusp of puberty (mean age 13). This project is a collaboration between Duke University
and Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania. Specific Aims are: 1) To
assess the impact of the Adolescent Wellness Visit model on HTC (primary outcome for all adolescents) and
contraceptive uptake (secondary outcome for sexually active adolescents) up to two years post-primary school
via a cluster randomized controlled trial (24 school-clinic pairs: 12 intervention + 12 control; n=552
adolescents); 2) To evaluate factors that support or limit implementation of the AWV model and
fidelity/adherence to implementation of the proposed package of evidence-based practices included in the
AWV; and 3)
To determine the cost-effectiveness of the AWV model for increased HIV testing, reaching
PEPFAR diagnostic targets, and reductions in unmet need for contraception. This D&I proposal creates and
leverages a new population level health service for adolescents that aligns with NICHD’s Research Theme #5:
Improving Health during the Transition from Adolescence to Adulthood (NOT-HD-18-031), and as a nurse-
delivered intervention, it also aligns with NINR’s strategic focus area—Wellness: Promoting Health and
Preventing Illness (16-NR-778). A prevention-focused adolescent health service in LMICs can set the tone for
a ‘culture of health and wellness’ during this critical developmental period.