Mainstreaming adolescent-responsive health care in partnership with youth

PATH partners with governments, civil society, and young people to:

• Integrate sexual and reproductive health (SRH), HIV prevention, maternal health, mental health, and gender-based violence prevention and response activities to more holistically meet the needs of youth, including through primary health care.
• Innovate through human-centered design to develop effective, rights-based models for addressing adolescent and youth SRH.
• Improve livelihoods through economic development opportunities for youth, linking these initiatives with integrated health education and service delivery.
• Institutionalize adolescent-responsive elements of SRH programs through youth-led policy advocacy and accountability activities.
• Support the technical and organizational capacity of local partners including youth-led organizations.
• Generate and disseminate evidence about what works in adolescent and youth SRH.

Policy advocacy with youth civil society organizations in Senegal to decrease early marriage and unintended pregnancy

Senegal has made significant advances in SRH over the past decade, more than doubling the modern method contraceptive prevalence rate from 12% to 26% from 2010 to 2019. Despite this progress, challenges continue to adversely affect the ability of adolescents, girls, and young women (AGYW) to access and utilize basic SRH care services in Senegal, where the population is notably young and early marriage and adolescent pregnancy are common. To address these challenges, PATH is collaborating with the World Health Organization, the Senegal Ministry of Health, and youth-led organizations to develop a high-impact strategy and costed operational plan to decrease early marriage and reduce unintended pregnancy among married and unmarried adolescents. PATH is employing a human-centered design approach that involves youth in all stages of the project, as well as gathering inputs from key stakeholders including youth association leaders, community and faith leaders, the Ministry of Health, and nongovernmental organizations. The project aims to improve youth rights at societal and structural levels, while also improving coordination across groups involved in AGYW programming. The strategy and operational plan will complement existing data, resulting in a fresh perspective and more tailored, inclusive, and empowering solutions for AGYW. By 2023, additional resources will need to be mobilized to implement the strategic plan developed by PATH and the Ministry of Health and continue work toward establishing a stronger enabling environment for the SRH of AGYW. With increased political attention, donor investments, and data, Senegal is well-positioned to reduce early marriage and unintended adolescent pregnancy in the coming years.

Technical assistance to government partners to improve sexual and reproductive health services for youth

PATH is also a member of the World Health Organization’s technical assistance coordination mechanism on adolescent and youth sexual and reproductive health and rights (AYSRHR). By providing technical assistance to countries that request support, PATH helps ensure that young people are able to access SRH information and services, that AYSRHR programs are well-designed, implemented, monitored, and documented, and that political processes and structures are better prepared to inclusively address the unique SRHR needs of young people. PATH’s technical assistance includes support to ministries of health to meaningfully engage adolescents and youth throughout the policy cycle. In addition, PATH is participating in the guideline development group to support updated World Health Organization guidelines on preventing child marriage, responding to the needs of married girls, and increasing access to and uptake of contraception among adolescents.

Building DREAMS in Kenya to prevent HIV among young women

In Kenya, PATH implements the majority of PEPFAR-funded HIV prevention Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) programs for AGYW in the highest HIV burden counties through the USAID/Afya Ziwani project (2017–2021) and its follow-on, USAID/Nuru Ya Mtoto (2021–2026). Through these projects, PATH provides a comprehensive package of evidence-informed behavioral, biomedical, and structural interventions for primary HIV prevention in AGYW aged 15 to 24. Under PATH-supported DREAMS programs, the project delivered age-appropriate interventions to a cumulative 307,338 AGYW in 2019–2021, established 260 “safe spaces” in communities where AGYW participate in group-based interventions, and offered AGYW financial capability training and peer-to-peer support. In addition to the direct support to AGYW, the team facilitates orientations, training, and on-the-job mentorship for nearly 65 nongovernmental and community-based organizations that implement components of PATH’s DREAMS program. The team also supports Ministry of Health partners to build capacity for youth-friendly services, pre-exposure prophylaxis (PrEP) provision, and training to prevent gender-based violence. PATH has also helped the national DREAMS program identify and enroll the most vulnerable AGYW and ensure that services are delivered in geographies with the highest HIV burden. Through implementation of DREAMS, we have established a deep understanding of the diverse and wide-ranging needs of AGYW through a model that is youth-centered, gender-responsive, and rights-based.

Supporting adolescent-friendly integration of contraception and HIV prevention in Uganda

PATH’s DMPA-SC Self-Injection Best Practices project (2017–2019) applied principles and tools of human-centered design to develop, implement, evaluate, and cost contraceptive services in the public and private sector, including safe spaces for AGYW in Uganda. We collaborated with Mildmay Uganda, a local non-governmental organization, to strengthen integration of contraceptive services with existing HIV programming for AGYW. PATH worked with Mildmay staff offering family planning (FP) through adolescent-friendly safe spaces; public areas such as schools and community centers where AGYW meet with female mentors and providers to receive HIV prevention and other health interventions and services. PATH and Mildmay collaborated to improve delivery of high-quality services centered around informed choice, routine program monitoring systems, and more frequent and regular outreach visits. This project to advance integrated FP and HIV service delivery for adolescents was evaluated to better understand adolescents’ experiences and preferences in Uganda’s contraceptive self-injection program. Results indicated that self-injection is a promising method for Ugandan adolescents, who should be actively included in accessing self-care for SRHR, and that policies and programs should ensure a range of contraceptive methods for AGYW. The Self-Injection Best Practices project results have helped advance youth-friendly and HIV prevention services in Uganda through inclusion of a module on AGYW-friendly services in the national FP provider training curriculum.

Co-creating adolescent mental health interventions in India

Young people are at the helm of shaping India’s future and deserve adequate support systems that will enable them to become productive adults. The range of mental health challenges that young people face are interconnected with many factors, including sexual and reproductive health. Yet the mental health and well-being of adolescents and young adults is a neglected topic—depression, anxiety, and substance abuse are all significant issues impacting Indian youth. To support and encourage the development of innovative mental health interventions for young people, including the use of accessible, effective, and safe digital mental health tools, PATH and Fondation Botnar launched Stakeholder-led Advancement of Mental Health of Young People, or SAMYP. The SAMYP team has conducted a policy landscaping exercise and needs assessment focused on adolescent mental health, gathering perspectives of stakeholders who have a role in the access, design, and implementation of mental health programs for young people. Technical and youth advisors, including young people with lived experiences of mental health conditions, provided insights and leadership to help improve youth access to mental health resources and support. Learnings from this landscape will be used as a launch pad to establish strong mental health programs and policies for young people, engaging them as co-creators in designing comprehensive mental health interventions that leverage digital technologies.

Reaching adolescents with HPV vaccines for cervical cancer prevention

For nearly two decades, PATH has been at the forefront of expanding AGYW’s access to vaccines against human papillomavirus (HPV), the virus that causes most cervical cancer. We support the planning, implementation, and evaluation of national HPV vaccination programs by providing technical assistance to countries eligible for funding from Gavi, the Vaccine Alliance. We also work with manufacturers to develop affordable vaccines, conduct research on vaccine costs and cost-effectiveness, and generate evidence on optimal HPV vaccination schedules, delivery, and policies. PATH has played a lead role on the Single-Dose HPV Vaccine Evaluation Consortium to evaluate evidence on single-dose vaccine which has demonstrated solid protection against HPV. PATH was also instrumental in establishing the global advocacy coalition, Cervical Cancer Action for Elimination, promoting awareness and policy change worldwide for HPV vaccines and cervical cancer screening.