Exploring differentiated service delivery strategies to optimize modern contraceptive uptake among adolescents with HIV in Northern Uganda: a mixed methods study

Abstract

<title>Abstract</title> Background In sub-Saharan Africa, contraceptive use among adolescents ranges from 21–42% with an unmet need of 53–64%. Therefore, client-centered strategies like the differentiated service delivery (DSD) model should be explored to improve contraceptive use among adolescents in Uganda. Methods An exploratory mixed-methods study was conducted in HIV positive adolescents 12–19 years at Gulu Regional Referral hospital in northern Uganda. Structured questionnaires were used to obtain information on contraceptive use, and the most convenient mode of delivery. Selected key informants identified specific delivery strategies potentially associated with higher contraceptive uptake. Results Of the 193 respondents who participated in the study, 108(56%) were females with a mean age of 15 years. Ever use of modern contraceptives was low at 16% because only a small percentage (approximately 20%) were sexually active. Most participants, 54/193 (40%) preferred accessing contraceptives from the adolescent clinic from health workers and peer supporters. Factors associated with increased contraceptive use were tertiary level education and employment. From qualitative analysis participants recommended separation of adolescent services, peer support and community outreaches to improve uptake. Conclusion The contraceptive prevalence rate among HIV-positive adolescents is still low. Contraceptive use is higher among the educated or employed. Services should be provided at adolescent-friendly clinics by trained health workers and peers during school holidays to optimize uptake.