Setting research priorities for adolescent sexual and reproductive health in low- and middle-income countries
Michelle J Hindin, Charlotte Sigurdson Christiansen & B Jane Ferguson
Volume 91, Number 1, January 2013, 10-18
Table 2. Summary of research questions that ranked highest when scored in accordance with five criteria, by outcome area
| Outcome area | Type of researcha | Total scoreb | Clarity scoreb | Answerability scoreb | Impact scoreb | Implementation scoreb | Equity scoreb |
|---|---|---|---|---|---|---|---|
| Maternal health (n = 20) | |||||||
| What strategies can improve the use of antenatal care, skilled birth attendants, PMTCT and postnatal care by adolescents in resource-poor settings? | B | 0.95 | 0.92 | 0.97 | 0.97 | 0.92 | 0.97 |
| What factors (including barriers and facilitators) are associated with the utilization of maternal health services (antenatal, intrapartum, postpartum) and neonatal care by adolescents in different settings? | A | 0.92 | 0.98 | 0.95 | 0.93 | 0.85 | 0.90 |
| What pregnancy outcomes (maternal and neonatal) among adolescents are related to mode of delivery, presence of a skilled birth attendant at delivery and care of infants up to 6 months of age? | A | 0.92 | 0.84 | 1.00 | 0.94 | 0.89 | 0.92 |
| Do programmes that promote postnatal family planning for adolescent mothers reduce subsequent unwanted pregnancies in this group? | A | 0.92 | 0.95 | 0.92 | 0.92 | 0.89 | 0.89 |
| Do adolescent girls and adult women receive different antenatal, delivery and postnatal care? If so, how and why? | A | 0.91 | 0.87 | 0.97 | 0.92 | 0.89 | 0.89 |
| Contraception (n = 22) | |||||||
| What strategies can delay first births among married adolescents? | A | 0.94 | 1.00 | 0.95 | 0.89 | 0.91 | 0.93 |
| Through what mechanisms can the provision of regular and emergency contraceptives to adolescents be financed or subsidized? | B | 0.94 | 0.93 | 0.95 | 0.95 | 0.93 | 0.91 |
| What strategies can increase consistent and effective condom use among both male and female adolescents? | B | 0.91 | 0.95 | 0.98 | 0.95 | 0.82 | 0.86 |
| What barriers do health-care providers face when trying to offer contraception services to unmarried adolescents? | A | 0.90 | 0.95 | 0.91 | 0.89 | 0.83 | 0.91 |
| In settings with high rates of pregnancy in adolescence, what factors protect adolescents from unwanted and/or unsafe pregnancy? | A | 0.89 | 0.86 | 0.95 | 0.91 | 0.84 | 0.86 |
| Gender-based violence (n = 18) | |||||||
| How do programmes that aim to keep girls in school longer through measures such as conditional cash transfers affect the prevalence of gender-based violence? | A | 0.97 | 1.00 | 0.97 | 0.97 | 0.86 | 0.94 |
| What interventions can be integrated into community settings (e.g. schools) to address gender-based violence and its related reproductive outcomes? | B | 0.89 | 0.89 | 0.92 | 0.89 | 0.89 | 0.89 |
| What strategies might reduce gender-based violence among adolescent sex workers? | B | 0.88 | 0.89 | 0.94 | 0.94 | 0.79 | 0.85 |
| How feasible, effective and sustainable is the training of community-based health workers on identification and referral of cases of gender-based violence? | B | 0.88 | 0.83 | 0.89 | 0.92 | 0.89 | 0.89 |
| What is the impact of “healthy schools” initiatives on the reduction in gender-based violence? | A | 0.87 | 0.83 | 0.94 | 0.92 | 0.86 | 0.91 |
| HIV treatment and care (n = 21) | |||||||
| What factors facilitate uptake, retention and adherence and minimize treatment failure among adolescents? | B | 0.95 | 0.98 | 0.95 | 0.95 | 0.95 | 0.93 |
| How do user fees affect access to, use of and retention in treatment among adolescents living with HIV? | B | 0.95 | 1.00 | 0.93 | 0.95 | 0.95 | 0.93 |
| What factors influence the disclosure of HIV status to others among adolescents? | A | 0.92 | 0.98 | 0.93 | 0.93 | 0.95 | 0.81 |
| What proportion of young women who test positive for HIV in antenatal or delivery care: (i) receive and take drugs for PMTCT; (ii) are assessed to determine if they need lifelong HAART; (iii) are started on lifelong HAART if clinically indicated? | A | 0.92 | 0.95 | 0.95 | 0.95 | 0.88 | 0.88 |
| What aspects of the delivery of HIV testing and counselling services are most important from the perspective of adolescents: the speed of the results; confidentiality and anonymity; the social and health services offered; the counselling offered; whether or not they are integrated into the health system? | B | 0.91 | 0.95 | 0.90 | 0.93 | 0.88 | 0.88 |
| Abortion (n = 19) | |||||||
| How does the provision of contraceptive methods (especially long-acting, reversible methods) as part of post-abortion care affect unintended pregnancy and repeat abortion rates among adolescents? | A | 0.95 | 0.97 | 0.92 | 0.97 | 0.92 | 0.95 |
| What interventions are effective for informing adolescents about the availability and safe use of misoprostol? | B | 0.94 | 1.00 | 0.95 | 0.95 | 0.89 | 0.92 |
| How does cost influence adolescents’ abortion-seeking behaviour? | B | 0.91 | 0.87 | 0.97 | 0.89 | 0.87 | 0.87 |
| How much awareness of abortion law, access to safe abortion services and post-abortion care exists among adolescents? | A | 0.91 | 0.89 | 0.97 | 0.89 | 0.89 | 0.89 |
| What do adolescents know about less invasive procedures for pregnancy termination and post-abortion care (e.g. misoprostol), and to what extent do they have access to them or use them? | A | 0.88 | 0.92 | 0.92 | 0.84 | 0.82 | 0.88 |
| FP and HIV service integration (n = 23) | |||||||
| What modalities for delivering integrated HIV/FP services to adolescent boys work best? | B | 0.90 | 0.83 | 0.89 | 0.89 | 0.81 | 0.96 |
| Does the provision of comprehensive sex education at school: (i) reduce adolescent pregnancies, (ii) increase health-care seeking behaviour among adolescents, or (iii) reduce the incidence of STIs, including HIV infection? | A | 0.88 | 0.93 | 0.87 | 0.87 | 0.83 | 0.89 |
| What are the most effective and affordable models for delivering integrated contraception and HIV services and information to young married couples? | B | 0.88 | 0.91 | 0.93 | 0.87 | 0.83 | 0.85 |
| What female-controlled methods for preventing both STIs and pregnancy can be developed and tested? | C | 0.88 | 0.86 | 0.95 | 0.90 | 0.85 | 0.85 |
| How much do young female sex workers and injecting drug users need and use contraceptives?? | A | 0.85 | 0.93 | 0.78 | 0.85 | 0.78 | 0.91 |
| STIs and HPV infection (n = 21) | |||||||
| What alternative dosing schedules can facilitate HPV vaccine delivery in low-resource settings? | C | 0.93 | 1.00 | 0.93 | 0.98 | 0.83 | 0.90 |
| How can school-based and community-based programmes for STI counselling and testing, HPV vaccination and sex education be scaled up? | B | 0.90 | 0.90 | 1.00 | 0.90 | 0.86 | 0.83 |
| What are the most effective, efficient and sustainable ways to deliver vaccination against HPV? | B | 0.86 | 0.81 | 0.93 | 0.88 | 0.79 | 0.88 |
| How can adolescents who do not use available STI services (e.g. conditional cash transfers, mobile clinics) be reached? | B | 0.86 | 0.86 | 0.93 | 0.93 | 0.76 | 0.81 |
| What is the cost-effectiveness of HIV/STI screening programmes among adolescents at highest risk? | B | 0.84 | 0.86 | 0.83 | 0.81 | 0.83 | 0.88 |
| How can the incorporation of syphilis testing in SRH and maternal health services be optimized to ensure that all adolescents, including pregnant girls, get screened and treated? | B | 0.84 | 0.76 | 0.90 | 0.88 | 0.79 | 0.86 |
FP, family planning; HAART, highly-active antiretroviral therapy; HIV, human immunodeficiency virus; HPV, human papillomavirus; PMTCT, prevention of mother-to-child transmission; SRH, sexual and reproductive health; STI, sexually-transmitted infection.
a Type of research was divided into the following categories: A – descriptive: epidemiological research/evaluation of existing interventions; B – development: operations research/scaling up of existing interventions; C – discovery: new interventions.
b The highest possible score is 1.