How and why do young people engage in STI screening, treatment, and partner notification? A qualitative positive deviance study in Zimbabwe.

Abstract

Young people have a high burden of sexually transmitted infections (STIs) but low uptake of and high attrition from services. We adopted a positive deviance approach to explore uptake of STI screening, treatment, and partner notification within a sexual and reproductive health service. We conducted in-depth interviews with young people (aged 16-24 years) who accepted screening, treatment, and partner notification slips (n = 15), and healthcare providers who delivered the service (n = 13). We used thematic analysis to understand decisions at each stage of the STI care cascade. Young people who accepted STI screening and returned to receive their results were influenced by the friendliness and informativeness of providers, which helped overcome their anxiety. Experiencing symptoms and health being a priority were also motivators to seek treatment and overcame the inconvenience of returning to the service and the fear of the test result. While all participants accepted partner notification slips, only those in secure relationships felt able to tell their partners. This study identified both supply (positive provider attitudes, information provision, and same-day treatment provision) and demand side factors (prioritise one's health, experiencing symptoms, and knowledge about asymptomatic infections) that STI interventions can build on to support young people's engagement with STI services.