The Yathu Yathu strategy
Yathu Yathu was implemented between 2019 and 2021. The strategy consisted of community-based delivery of comprehensive SRH services, including HIV testing, contraceptives, and menstrual products (free disposable pads and the menstrual cup). Services were delivered by peer support workers at spaces (hubs) in a central location in each zone that was randomly allocated to the intervention arm (n = 10 hubs). Peer support workers managed the day-to-day activities at the hubs and provided information to AYP, either one-to-one or through comprehensive sexuality education sessions. When accessing services, AYP could collect points for services accessed. The numbers of points redeemable for the services accessed were dependent on the anticipated psychological difficulty of accessing individual services. For menstrual products, collecting pads was initially redeemable at 65 points but, after adaptations to the intervention design, no points were redeemable for collecting pads as it was found that accessing pads from hubs posed little to no psychological difficultly for AGYW [Menstrual cups were donated to Yathu Yathu by Menstrual products were also available for “purchase” as rewards (reusable pads, tampons and branded disposable pads) using points AGYW accrued for accessing services, in addition to other rewards such as soap, toothbrush, toothpaste. Although one-point was equivalent to 0.05 Kwacha (USD 0.002), to facilitate access to better quality and reusable menstrual products, the menstrual products that were available as rewards could be accessed for fewer points than their market value (Table Menstrual products available through Yathu Yathu as a (free) service or reward and the points associated with these products*Before adaptations—the pilot implementation phase, between Sept 2019 and Feb 2020, before changes were made to the system based on lessons learnt from this pilot implementation