For nearly 20 years, Joy Noel Baumgartner has focused much of her research on interventions that promote equitable access to reproductive health services and HIV testing in low and middle-income countries, primarily in sub-Saharan Africa. Such efforts have been designed with the hope that if young people are aware of and have more opportunities to receive health services, the more likely they will see health providers regularly later in life and maintain better health.
Nevertheless, researchers have learned that adolescents, especially those at greatest risk of unintended pregnancies or sexually transmitted infections, don’t often take the initiative to visit a health clinic on their own, said Baumgartner, a Wallace Kuralt Early Career Distinguished Scholar who joined the School’s faculty in January.
However, based on findings from a recently completed pilot study, Baumgartner and her research collaborators at Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania, think they may have discovered a more effective way of tackling this challenge. Rather than waiting on younger patients to potentially seek out services, community health clinics should partner with local schools to bring entire classrooms of students in for wellness visits.
Thanks to a $3.1 million R01 grant from the National Institutes of Health (NIH), Baumgartner and co-principal investigator Sylvia Kaaya, professor of Psychiatry and Mental Health at MUHAS, are launching a new five-year project that aims to do just that. Their study will flip the traditional health services model by working closely with schools to bring every young adolescent, around age 13, and enrolled in their last year of primary school into the clinics. The school field trip will allow nurses and doctors to provide all students with information on reproductive health and HIV testing and give them the chance to assess each child’s overall health.
“The previous models we were coming up with focused on making a clinic super adolescent friendly and making sure the word was getting out that teens have access to these reproductive health services,” said Baumgartner, an associate professor. “We know how to create “adolescent-friendly” health services, but it still put the onus on them to self-identify as needing these services and then to come in for them.”
By bringing in every student for a checkup, regardless of any particular need or anticipated risk for unintended pregnancy or HIV, health providers ensure that HIV testing and reproductive health information is available and provided to everyone, Baumgartner added.
“Very few will probably even need the services now, but the hope is that they will have had a positive experience in the clinic and come back in the next couple of years when they may actually need services,” she said.
During the wellness visits, health care providers also check the students for any vision and dental health problems and assess for nutritional and mental health issues.
The recently completed pilot study, also funded by NIH, involved 154 students in two schools and was well-received, especially among Tanzanian parents, Baumgartner said. Generally, because checkups are not recommended for children after age 5, many rarely see a clinician unless they are sick. As a result, adolescents may not receive needed preventative health services that can benefit them long-term, she said.
The pilot study confirmed the need for such preventative services as nurses identified a number of adolescents with vision and dental problems. Although none were identified as sexually active, they did find children who had been sexually abused. These adolescents were referred to social workers and for additional services, Baumgartner said.
With their latest NIH study, Baumgartner and Kaaya plan to enroll 550 students across 24 schools in Tanzania. Among the goals, the researchers hope to learn if there is an increase in HIV testing among the study participants and if those who are sexually active by age 16 are using contraceptives at their first sexual encounter.
Their findings may help to inform recommendations to the World Health Organization, which is currently working to identify guidelines for what low- and middle-income countries should require for adolescent health services, Baumgartner said. Kaaya also thinks the study may help to strengthen policies to provide adolescents greater access to health insurance.
“Because children between the ages of zero to 18 years old are often considered the healthiest, they face numerous challenges to accessing health services,” Kaaya said.
Long-term, ensuring that health services are available to adolescents early in life can help prevent further health problems and diseases down the road, Baumgartner added. For example, untreated, STIs are a problem that can affect infertility in women and have significant and long-lasting repercussions on their health, she said. Helping young people understand these consequences and the importance of accessing services early is vital, she added.
“There are both health- and cost-related benefits to these prevention services,” she said. “Ultimately, we believe it’s more beneficial for the government to spend more money now to support preventative services so that they don’t have to pay more for the sick visits and chronic illnesses later on.”