Supplementary file 4_Implementing voluntary counselling and testing services among university students in Mozambique: a mixed methods process evaluation.pdf

Introduction

Understanding the relationship between the program implementation and its context is a key strategy for explaining why a program produces its effects and for informing decisions about its adaptation. We evaluated the implementation of a program promoting the use of Voluntary Counseling and Testing (VCT) among university students.

Methods

The study was conducted at the Universidade Católica de Moçambique using a mixed-methods approach to examine context, reach, dose, and fidelity. Data collection involved observation, interviews, and focus group discussion (FGDs). The study participants included teachers, peer activists, health advisors, and program users. Peer activists were eligible if they were actively engaged in sensitization activities. Health advisors and life skills teachers were required to hold a valid full-time employment contract with UCM. Users were eligible if they were first-year student aged 16 to 25 years. Quantitative data were analyzed using descriptive statistics. FGD data were analyzed using thematic analysis.

Results

The implementation context was shaped by compliance with preventive measures against the COVID-19 pandemic. Attendance at life skills lessons was high, with more than half of users reporting attendance at 70–100% of scheduled lessons. Attendance at sensitization sessions was also acceptable, with nearly half of users reporting attendance at 70–100% of scheduled sessions. A notable number of participants were not reached by VCT, and implementation fidelity was not fully maintained across all program components. Users indicated that initial exposure to the program elicited emotional responses; however, over time, they normalized the topic and became more comfortable discussing sexuality. Persistent challenges hindered engagement with VCT. Consequently, users recommend expanding the program and making it more inclusive; improving the overall delivery; and reviewing the timing, duration, frequency, as well as diversifying the content of awareness.

Conclusion

The results of this study contribute meaningful and updated evidence on the implementation of VCT promotion programs at university in resource-limited settings. These findings may guide the future development, implementation, and adaptation of VCT promotion programs in similar contexts. We therefore recommend that the future implementation be informed by evidence and recommendations drawn from program users.