Empowering adolescents and young adults in health decision-making requires an adaptable approach considering individual experiences, interpersonal influences and systemic factors to enhance engagement with healthcare services, increase service utilisation and treatment adherence in Chad.
Key Findings
Background
Adolescents and young adults (AYA) aged 15-24 in Chad account for 26.3% of new HIV infections, with young women facing four times the risk compared with young men.
National HIV prevalence in Chad decreased from 1.6% in 2010 to 1.0% in 2022, yet AYA remain disproportionately affected.
Globally, AYA aged 15-24 account for nearly half of all new HIV infections, with over 80% residing in sub-Saharan Africa.
AIDS is described as a leading cause of death among AYA in sub-Saharan Africa.
Background
Antiretroviral therapy (ART) coverage in Chad was only 47% overall in 2023, with stark gender disparities between male and female AYA.
Only 27% of males were receiving ART treatment compared with 58% of females.
Barriers throughout the care continuum, including transitions from paediatric to adult services, were identified as contributing factors to low coverage.
These challenges were noted to impact both access to sexual and reproductive health services and effective help-seeking behavior.
Methods
The study used participatory action research with a sensemaking theoretical lens to understand how AYA in Chad navigate and interpret the healthcare system.
Data were collected from December 2021 to March 2024.
52 AYA aged 15-24, both HIV-positive and HIV-negative, participated in focus group discussions.
Data were analysed using a modified grounded theory approach, with coding and category development guided by the constant comparison method.
The sensemaking theoretical lens was applied to illuminate how AYA interpret their healthcare experiences.
Results
Empowering AYA in health decision-making requires an adaptable approach that considers individual experiences, interpersonal influences, and systemic factors.
Findings identified three levels of influence on AYA health decision-making: individual experiences, interpersonal influences, and systemic factors.
Such an approach was found capable of enhancing engagement with healthcare services and increasing service utilisation and treatment adherence.
The approach was also noted to inform policy redesign for more effective service delivery.
Results
AYA-friendly services that foster clear communication, trust, and responsive care were identified as essential needs for improving healthcare utilisation among AYA in Chad.
The study highlights that current services do not adequately address AYA perspectives and communication needs.
Trust between AYA and healthcare providers was identified as a key factor influencing service utilisation.
Responsive care was noted as a critical component of retaining AYA in the care continuum.
Discussion
Strengthening health systems through adolescent-responsive policies, workforce training, and decentralised service delivery can enhance AYA engagement and retention in care.
Decentralised service delivery was identified as a structural reform needed to improve accessibility for AYA.
Workforce training was highlighted as necessary to make services more responsive to adolescent needs.
Community-driven approaches and system reforms were recommended to align services with AYA perspectives.
These system-level changes were linked to potential improvements in healthcare accessibility and outcomes in similar contexts.
What This Means
This research studied how young people aged 15-24 in Chad seek out and use sexual and reproductive health services, including HIV testing and treatment. The researchers worked directly with 52 young people over about two years, using a method called participatory action research, where participants help shape the research process itself. They found that young people's decisions about whether to use health services are shaped by a complex mix of their own personal experiences, their relationships with family and peers, and broader factors like how health systems are organized and staffed. Notably, the study found that only about half of young people living with HIV in Chad were receiving treatment, and young men were far less likely to be in treatment than young women.
The study found that for young people to engage meaningfully with healthcare, services need to feel welcoming, trustworthy, and genuinely responsive to their needs. When young people do not feel understood or respected in healthcare settings, or when services are too far away or poorly designed for their age group, they are less likely to seek help or stay in treatment. The researchers describe this as a problem of 'sensemaking' — young people need to be able to understand and feel confident navigating the healthcare system in order to use it effectively.
This research suggests that improving HIV and sexual health outcomes for young people in Chad — and in similar settings across sub-Saharan Africa — requires changes at multiple levels simultaneously. Health policies need to be designed with young people's needs specifically in mind, health workers need training to interact effectively with adolescents, and services should be brought closer to communities. Involving young people themselves in designing and evaluating health programs may be key to making these improvements work in practice.
Bedingar E, Paningar F, Bedingar N, Mbaidoum E, Ngaradoum N, Atun R, et al.. (2025). Optimising adolescents and young adults' utilisation of sexual and reproductive health and HIV services in Chad: a sensemaking approach.. BMJ global health. https://doi.org/10.1136/bmjgh-2024-017763