A systematic review of the effectiveness of participatory, health system-based interventions to improve the sexual and reproductive health and rights of adolescent girls and young women in Sub-Saharan Africa.

This systematic review investigates the impact of participatory health-sector led interventions on female adolescent sexual and reproductive health and rights (ASRHR) in Sub-Saharan Africa. Adolescents face many challenges, including high rates of HIV and other risk factors. Interventions to promote ASRHR are therefore critical for enhancing their overall wellbeing. Our peer-reviewed search yielded 6225 articles from online databases, which we imported to Covidence. 2619 duplicates were removed, leaving 3606 articles that two authors screened by title and abstract. 3545 articles not meeting our inclusion criteria were removed, and 61 full-text articles were screened, also by two authors. Only four articles met our eligibility criteria. The interventions in the selected studies included HIV testing preferences in Zambia, layered interventions in Malawi, peer support for HIV testing and adherence in Uganda, and a participatory curriculum in Zimbabwe. Important results included the value adolescents attached to interventions delivered by health providers; the need for interventions to address ASRHR issues in a comprehensive way; and the need for more rigorous indicators of the nature and role of peer support in ASRHR interventions. Several unexpected findings included the paucity of studies on participatory youth-friendly interventions delivered by the health sector, the dominance of adolescent research on HIV issues and the neglect of other priorities, and the limited research attention to adolescent rights. We conclude that investing in the formation and sensitisation of African health workers to adolescent needs can have a positive and sustainable impact, although further research is needed to validate these findings.