Abstract
BACKGROUND: Household visits from community health workers can improve adolescent girls and young women's (AGYW) healthcare seeking and access to services. This study aimed to evaluate whether engagement with community health volunteers (CHVs) is associated with health facility visits, contraceptive use and the fulfilment of family planning needs among AGYW in Kenya. METHODS: We analysed data from three waves of Kenya's Performance Monitoring for Action cohort, collected between 2019 and 2022. The analysis focused on 3394 AGYW aged 15-24 years who had ever had sex (observations across the three waves=5784). Multivariable mixed-effects unconditional logistic regression was used to evaluate within-individual associations between past-year CHV household visits to talk about family planning and three outcomes: (1) health facility visits; (2) modern contraception use; and (3) unmet need for modern contraception. FINDINGS: The prevalence of modern contraceptive use and unmet need for family planning among AGYW was 47% and 25%, respectively. 11% were visited by a CHV in the last year. Comparing within individuals across study waves, visits by a CHV increased the likelihood of visiting a health facility (adjusted prevalence ratio (aPR) 1.23, 95% CI 1.14 to 1.31). The combination of a CHV visit and health facility visit showed moderate evidence of increasing the likelihood of modern contraception use (aPR 1.17, 95% CI 1.01 to 1.29), but no evidence of decreasing unmet need for modern contraception (aPR 0.71, 95% CI 0.41 to 1.01). CONCLUSION: Household visits by CHVs are likely to connect AGYW to health facilities and support increased contraceptive use. However, it remains unclear if these visits ultimately reduce unmet need for modern contraception among AGYW.