Increasing young people's use of sexual and reproductive health services in government health facilities in rural Kenya.

AHAP increased young people's use of SRH services by 87% overall after one year.

• The full intervention arm achieved a 97% increase in SRH service use by young people.
• The partial intervention arm achieved a 77% increase in SRH service use by young people.
• Comparison facilities saw no change in SRH service use over the same period.
• The study used a randomized cluster design across thirteen government health facilities in Western Kenya.

The full intervention attracted significantly more female and younger SRH clients compared to other study arms.

• The full intervention included AHAP nurses conducting comprehensive sexuality education (CSE) classes in nearby schools and community locations.
• The partial intervention was entirely clinic-based and did not include school or community outreach.
• The differential effect on client demographics (younger and more female clients) was specific to the full intervention facilities.

Improvements in nurse SRH attitudes following AHAP training were sustained after one year.

• AHAP nurses were newly-graduated nurses specifically trained as part of the intervention.
• The sustained attitude improvement suggests training effects persisted through the one-year study period.
• Nurse training was a core component of both the full and partial intervention arms.

AHAP was designed as a low-cost intervention using two main strategies: extending clinic hours into early evening and training newly-graduated nurses.

• Clinic hours were extended into early evening to improve convenience and confidentiality for young people.
• Newly-graduated nurses were recruited and trained to serve as AHAP nurses.
• The intervention addressed psychosocial barriers including provider judgment, lack of privacy, community visibility, and contraceptive misconceptions.
• Despite being low-cost in design, the intervention requires ongoing budget outlays for nurse salaries.

Young people in rural sub-Saharan Africa face multiple geographic and psychosocial barriers to accessing SRH services.

• Adolescents worry that providers will be judgmental and not accord them privacy and confidentiality.
• Young people are concerned that community members or extended family may see them waiting for SRH services, potentially leading to parental perceptions of promiscuity and punishment.
• Lack of comprehensive sexuality education (CSE) in schools leads to serious misconceptions about contraceptives.
• The study was conducted in Western Kenya, a rural setting.

The study used a randomized cluster design with thirteen government health facilities divided into full intervention, partial intervention, and comparison arms.

• Thirteen government health facilities in Western Kenya were included in the study.
• Facilities were randomized to one of three conditions: full intervention, partial intervention, or comparison.
• The study duration was one year.
• The full intervention included both clinic-based services and community/school CSE outreach, while the partial intervention was clinic-based only.