‘ <i>I can get all the services I want, without fear of being judged</i> ’: Acceptability of a sexual and reproductive health service for youth in Zimbabwe

Sexual and reproductive health (SRH) services often do not appeal to youth, leading to limited engagement and poor outcomes. We co-designed a community-based integrated HIV and SRH service with and for youth (16-24 years) in Zimbabwe (CHIEDZA) and investigated its acceptability. Qualitative data from observations of CHIEDZA services (<i>n</i> = 58), and in-depth interviews with healthcare providers (<i>n</i> = 51), mobilisers (<i>n</i> = 23), and clients (<i>n</i> = 63) were analysed inductively and thematically. Participants who attended CHIEDZA in an endline population-based survey completed a questionnaire assessing their experiences. 96.1% of attendees rated their experience as excellent/very good. Four key features were core to CHIEDZA's acceptability. First, in a context where ordinarily '<i>condoms and [menstrual] pads are expensive</i>', and clinics charge user fees, free services at CHIEDZA were valued. Second, integrated SRH services was seen as convenient and increased service uptake: '<i>I came wanting pads, and then also got tested for HIV</i>'. Third, youth-focused '<i>open-minded</i>' interactions with healthcare providers were central to acceptability. Fourth, a social and safe space for youth was popular. The key reasons for non-attendance was not knowing about CHIEDZA and distance. Youth engagement with SRH services could be enhanced by offering free-of-cost, integrated services and supporting healthcare providers to deliver compassionate and youth-focused care.