Background Many young people, particularly those who are marginalised and most at risk for HIV and reproductive health-related problems, cannot or will not seek traditional facility-based health services. Policies and programs are being implemented to provide them with these health services in the community. We sought to systematically review the effectiveness of such community-based HIV and reproductive health service policies and programs delivered via outreach on increasing health service utilisation among adolescents and young adults (ie, among 10–24 year olds).
Methods A systematic literature review of literature published prior to March 2010 was undertaken to identify policies promoting or programs delivering HIV or reproductive health services in the community. We reviewed studies that evaluated uptake of services or commodities. Data from studies meeting inclusion criteria were qualitatively analysed.
Results 20 studies met inclusion criteria, including 10 containing comparative data (eg, before and after study or control study design). The studies generally demonstrated positive impact, although results varied across settings and approaches. The most successful approaches included mail-based chlamydia screening in the Netherlands, condom distribution via street outreach in Louisiana, home-based HIV counselling and testing in Malawi, and promotion of over-the-counter access to emergency contraception in various countries.
Conclusions Overall, the studies suggest that out-of-facility approaches can be important avenues to reach marginalised youth. Rigorous implementation research is needed to assess the true impact that such strategies can have. Determining ways to effectively reach adolescents and young adults with HIV and reproductive health services is crucial in reducing not only youth morbidity and mortality but also in mitigating adult disease burden.
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