School-going learners are more likely to access HIV and contraceptive care at locations with friendly providers, Wi-Fi and other value-added services: Findings from a discrete choice experiment among learners in Gauteng, South Africa.

BackgroundMany Adolescents in Sub-Saharan Africa dont access HIV and reproductive health services optimally. To improve uptake of these services, it is important to understand the students preferences for how services are delivered so that implementation strategies can reflect this. MethodsA discrete choice experiment (DCE) was used to elicit preferences. The DCE was conducted in 10 high schools situated in neighbourhoods of varying socio-economic status (SES) in Gauteng (South Africa). Students aged [≥]15 years (Grades 9-12) were consented and enrolled in the DCE. Conditional logistic regression was used to determine preferred attributes for HIV and contraceptive service delivery. Results were stratified by gender and neighbourhood SES quintile. (1=Lowest SES; 5=Highest SES). ResultsThe DCE was completed between 07/2018-09/2019; 805 students were enrolled (67% female; 66% 15-17 years; 51% in grades 9-10). 54% of students in quintile 1 schools had no monthly income; 38% in quintile 5 schools had access to USD7 per month. Preferences were similar for male and female students. Students strongly preferred services provided by friendly, non-judgmental staff (Odds ratio 1.63; 95% Confidence Interval: 1.55-1.72) where confidentiality was ensured (1.33; 1.26-1.40). They preferred services offered after school (1.14; 1.04-1.25) with value-added services like free Wi-Fi (1.19; 1.07-1.32), food (1.23; 1.11-1.37) and youth-only waiting areas (1.18; 1.07-1.32). Students did not have a specific location preference, but preferred not to receive services within the community (0.82; 0.74-0.91) or school (0.88; 0.80-0.96). Students attending schools in high SES neighbourhoods expressed a preference for private care (1.15; 0.98-1.35). Costs to access services were a deterrent for most students irrespective of school neighbourhood; female students were deterred by costs [≥]USD3 (0.79; 0.70-0.91); males by costs [≥]USD7 (0.86; 0.74-1.00) ConclusionsPreferences that encourage utilisation of services do not significantly differ by gender or school neighbourhood SES. Staff attitude and confidentiality are key issues affecting students decisions to access HIV and contraceptive services. Addressing how healthcare providers respond to young people seeking sexual and reproductive health services is critical for improving adolescents uptake of these services.