title: Scale-up of adolescent contraceptive services: lessons from a 5-country comparative analysis.
abstract: BACKGROUND
  Poor sexual and reproductive health outcomes among adolescents aged 10-19 years are indicative of the barriers this group faces in accessing health services and highlights a gap in the availability of appropriate services, including adolescent-friendly contraceptive services (AFCS). The HIV Investment Framework identifies contraceptive services as an entry point for HIV counseling, testing, and treatment, and as a component of HIV prevention. To effectively meet the needs of adolescents, greater understanding of effective scale-up strategies for adolescent-friendly services is needed.
  
  
  METHODS
  The authors conducted a retrospective analysis of AFCS scale-up experiences in Ethiopia, Ghana, Mozambique, Tanzania, and Vietnam using the ExpandNet/World Health Organization framework for systematic scale-up. The authors analyzed the type of scale (expansion or institutionalization), dissemination and advocacy, organizational process, costs and resource mobilization, and monitoring and evaluation.
  
  
  RESULTS
  The analysis showed that all programs simultaneously pursued expansion and institutionalization, contributing to sustainable scale-up. Advocacy complemented by intensive capacity building at all levels of the health system contributed to adoption of AFCS in national and district work plans and budgets as well strengthening collection of age-disaggregated data.
  
  
  CONCLUSIONS
  To achieve scale-up of AFCS, the authors identified the importance of institutionalization and expansion in tandem for synergy and reinforcement, empowering adolescents to be agents of change and hold government accountable to its commitments, and strengthening health systems to sustain AFCS.
  
  
  CONCLUSIONS
  This article contributes to a growing body of evidence around scale-up of AFCS, which can inform the implementation and sustainable scale-up of HIV and other services for adolescents.
authors.affiliation: *Pathfinder International, Watertown, MA; †Technical Division, Sexual and Reproductive Health Branch, United Nations Population Fund, New York, NY; and ‡Partners in Expanding Health Quality and Access and ExpandNet Secretariat, Davis, CA.
authors.forename: Gwyn
authors.initials: G
authors.lastname: Hainsworth
authors.forename: Danielle Marie Claire
authors.initials: DM
authors.lastname: Engel
authors.forename: Callie
authors.initials: C
authors.lastname: Simon
authors.forename: Minal
authors.initials: M
authors.lastname: Rahimtoola
authors.forename: Laura Jane
authors.initials: LJ
authors.lastname: Ghiron
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D017954:Africa South of the Sahara; D002648:Child; D003267:Contraception / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D014744:Vietnam; D055815:Young Adult