Caregiver attitudes towards HIV testing and contraceptive services for adolescents in Tanzania

Adolescents are disproportionately vulnerable to unintended pregnancies and delayed HIV treatment in low-resource settings. Tanzanian policies support adolescent access to contraception and HIV testing and counseling (HTC) without parental consent if needed; however, parent/guardian disapproval could lead to unmet service needs. This qualitative study explores factors that influence caregivers' attitudes towards adolescents accessing these services independently. VITAA is a cluster RCT testing a school-clinic partnership to provide adolescent health check-ups in Tanzania. Semi-structured interviews (n = 42) were conducted with a purposeful sample of parents/guardians (74% women) of VITAA participants. The extended theory of planned behavior for parent-for-child health behaviors informed thematic analysis. Many parents/guardians expressed hesitancy about adolescents accessing services independently. Contraception concerns included community norms about adolescents being too young for sex and fears that access to contraception decreases parents' behavioral control over adolescents. Conversely, many caregivers endorsed positive attitudes towards HTC, but they had worries about adolescents receiving positive test results alone. Parent/guardian attitudes shape adolescents' health-seeking behaviors and Tanzanian parents and guardians are hesitant about adolescents' independent service use for diverse reasons, including its potential relationship with sexual debut. Tailored communication interventions could encourage caregivers' support for adolescent service access to meet community goals for healthy adolescents.<b>Trial registration:</b> ClinicalTrials.gov identifier: NCT05306938..