{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T06:19:14Z","timestamp":1787552354786,"version":"build-2736575974"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The study was conducted at the\n                      <jats:italic>Universidade Cat\u00f3lica de Mo\u00e7ambique<\/jats:italic>\n                      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\u202fyears. Quantitative data were analyzed using descriptive statistics. FGD data were analyzed using thematic analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2013100% of scheduled lessons. Attendance at sensitization sessions was also acceptable, with nearly half of users reporting attendance at 70\u2013100% 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1911945","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:28:00Z","timestamp":1787549280000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementing voluntary counselling and testing services among university students in Mozambique: a mixed methods process evaluation"],"prefix":"10.3389","volume":"14","author":[{"given":"Arlinda Bas\u00edlio","family":"Zango","sequence":"first","affiliation":[{"name":"Departamento de Investiga\u00e7\u00e3o em Sa\u00fade e Bem-Estar, Faculdade de Ci\u00eancias de Sa\u00fade, Universidade Cat\u00f3lica de Mo\u00e7ambique","place":["Beira, Mozambique"]},{"name":"Department of Health Promotion, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University","place":["Maastricht, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E.","family":"Stutterheim","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University","place":["Maastricht, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rik","family":"Crutzen","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University","place":["Maastricht, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"h1258","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"Moore","year":"2015","journal-title":"BMJ"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s13012-015-0236-y","article-title":"Factors influencing implementation dose and fidelity thereof and related student outcomes of an evidence-based national HIV prevention program","volume":"10","author":"Wang","year":"2015","journal-title":"Implement Sci"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1186\/s13063-020-04880-4","article-title":"Designing process evaluations using case study to explore the context of complex interventions evaluated in trials","volume":"21","author":"Grant","year":"2020","journal-title":"Trials"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1186\/s12913-016-1651-8","article-title":"Process evaluation for complex interventions in health services research: analysing context, text trajectories and disruptions","volume":"16","author":"Murdoch","year":"2016","journal-title":"BMC Health Serv Res"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"5740654","DOI":"10.1155\/2020\/5740654","article-title":"Understanding the role of voluntary counseling and testing (VCT) in HIV prevention in Nantong, China","volume":"2020","author":"Xu","year":"2020","journal-title":"Biomed Res Int"},{"key":"ref6","volume-title":"Directriz Nacional Para Implementa\u00e7\u00e3o do Aconselhamento e Testagem em Sa\u00fade","author":"M\u00e9doca","year":"2015"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"503","DOI":"10.2147\/HIV.S422516","article-title":"Implementation evaluation of HIV\/AIDS voluntary counseling and testing (VCT) Service at Public Health Facilities of Akaki Kality Sub-City, Addis Ababa, Ethiopia","volume":"15","author":"Masrie","year":"2023","journal-title":"HIV AIDS (Auckl)"},{"key":"ref8","volume-title":"Global Task Team for Setting for 2030 HIV Targets","year":"2025"},{"key":"ref9","volume-title":"Factsheet World Health Organization","year":"2025"},{"key":"ref10","volume-title":"IN DANGER: UNAIDS Global AIDS Update 2022","year":"2022"},{"key":"ref11","volume-title":"Inq\u00e9rito Nacional Sobre o Impacto do HIV e SIDA (INSIDA 2021): Relat\u00f3rio final","year":"2023"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1323926","DOI":"10.3389\/frph.2024.1323926","article-title":"Prevalence of sexually transmitted infections (STIs), associations with sociodemographic and behavioural factors, and assessment of the syndromic management of vaginal discharge in women with urogenital complaints in Mozambique","volume":"6","author":"Manjate","year":"2024","journal-title":"Front Reprod Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1155\/2020\/5740654","article-title":"Human papillomavirus prevalence and genotype distribution among young women and men in Maputo city, Mozambique","volume":"7","author":"Viegas","year":"2017","journal-title":"BMJ Open"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e0121452","DOI":"10.1371\/journal.pone.0121452","article-title":"Incidence of HIV and the prevalence of HIV, hepatitis B and syphilis among youths in Maputo, Mozambique: a cohort study","volume":"10","author":"Viegas","year":"2015","journal-title":"PLoS One"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1186\/s12913-024-11083-z","article-title":"Process evaluation of comprehensive sexuality education programme in Zambia: a focus on contextual factors, mechanisms of impact, quality of development and implementation process","volume":"24","author":"Mukanga","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1186\/s13063-024-08279-3","article-title":"A mixed methods process evaluation: understanding the implementation and delivery of HIV prevention services integrated within sexual reproductive health (SRH) with or without peer support amongst adolescents and young adults in rural KwaZulu-Natal, South Africa","volume":"25","author":"Zuma","year":"2024","journal-title":"Trials"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e048780","DOI":"10.1136\/bmjopen-2021-048780","article-title":"Process evaluation of peer-to-peer delivery of HIV self-testing and sexual health information to support HIV prevention among youth in rural KwaZulu-Natal, South Africa: qualitative analysis","volume":"12","author":"Adeagbo","year":"2022","journal-title":"BMJ Open"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.2147\/RMHP.S285317","article-title":"Level of implementation Fidelity of youth-friendly Services in Northwest Ethiopia","volume":"14","author":"Habitu","year":"2021","journal-title":"Risk Manag Healthc Policy"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3389\/frph.2021.745309","article-title":"Evaluation of a sexual transmitted infection prevention program among university students in Beira City Central Mozambique: a study protocol","volume":"3","author":"Zango","year":"2021","journal-title":"Front. Reproductive Health"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for reporting qualitative research: a synthesis of recommendations","volume":"89","author":"O'Brien","year":"2014","journal-title":"Acad Med"},{"key":"ref21","volume-title":"M\u00e9dicaDNdA, editor","year":"2015"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1177\/1525822x05279903","article-title":"How many interviews are enough?","volume":"18","author":"Guest","year":"2006","journal-title":"Field Methods"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1007\/s10488-013-0528-y","article-title":"Purposeful sampling for qualitative data collection and analysis in mixed method implementation research","volume":"42","author":"Palinkas","year":"2015","journal-title":"Admin Pol Ment Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1080\/14780887.2013.801543","article-title":"Sampling in interview-based qualitative research: a theoretical and practical guide","volume":"11","author":"Robinson","year":"2013","journal-title":"Qual Res Psychol"},{"key":"ref25","first-page":"24","volume-title":"APA Handbook of Research Methods in Psychology: Research Designs: Quantitative, Qualitative, Neuropsychological, and Biological","author":"Braun","year":"2023"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.cptl.2018.03.019","article-title":"Thematic analysis of qualitative research data: is it as easy as it sounds?","volume":"10","author":"Castleberry","year":"2018","journal-title":"Curr Pharm Teach Learn"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1177\/1609406917733847","article-title":"Thematic analysis: striving to meet the trustworthiness criteria","volume":"16","author":"Nowell","year":"2017","journal-title":"Int J Qual Methods"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1037\/qup0000196","article-title":"Conceptual and design thinking for thematic analysis","volume":"9","author":"Braun","year":"2022","journal-title":"Qual Psychol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.glmedi.2024.100051","article-title":"The pillars of trustworthiness in qualitative research","volume":"2","author":"Ahmed","year":"2024","journal-title":"J. Med. Surgery Public Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"150","DOI":"10.56249\/ijbr.03.01.44","article-title":"Criteria for assessing and ensuring the trustworthiness in qualitative research","volume":"4","author":"Kakar","year":"2023","journal-title":"Int. J. Business Reflections"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1111\/hiv.13180","article-title":"Impact of coronavirus disease (COVID-19) on HIV testing and care provision across four continents","volume":"23","author":"Rick","year":"2022","journal-title":"HIV Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1186\/s12913-022-07878-7","article-title":"Adapting community-based sexual and reproductive health services for adolescents and young people aged 15-24 years in response to COVID-19 in Lusaka, Zambia: the implications on the uptake of HIV testing services","volume":"22","author":"Phiri","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e158","DOI":"10.1016\/S2352-3018(20)30359-3","article-title":"The impact of the COVID-19 lockdown on HIV care in 65 south African primary care clinics: an interrupted time series analysis","volume":"8","author":"Dorward","year":"2021","journal-title":"Lancet HIV"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"15","DOI":"10.11604\/pamj.supp.2020.37.1.25443","article-title":"Preparedness of health facilities providing HIV services during COVID-19 pandemic and assessment of their compliance to COVID-19 prevention measures: findings from the Tanzania service provision assessment (SPA) survey","volume":"37","author":"Bajaria","year":"2020","journal-title":"Pan Afr Med J"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1007\/s10461-023-04139-4","article-title":"HIV testing disruptions and service adaptations during the COVID-19 pandemic: a systematic literature review","volume":"28","author":"Mude","year":"2024","journal-title":"AIDS Behav"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"3014","DOI":"10.1007\/s10461-020-02939-6","article-title":"COVID-19 lockdowns: impact on facility-based HIV testing and the case for the scaling up of home-based testing services in sub-Saharan Africa","volume":"24","author":"Mhango","year":"2020","journal-title":"AIDS Behav"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e055948","DOI":"10.1136\/bmjopen-2021-055948","article-title":"'We are not going anywhere': a qualitative study of Kenyan healthcare worker perspectives on adolescent HIV care engagement during the COVID-19 pandemic","volume":"12","author":"Enane","year":"2022","journal-title":"BMJ Open"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1186\/s41043-024-00718-w","article-title":"Implementation fidelity and client satisfaction in HIV testing and counseling services: perspectives from facilities and clients in Gondar city, Northwest Ethiopia","volume":"43","author":"Terefe","year":"2024","journal-title":"J Health Popul Nutr"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s13178-021-00651-1","article-title":"Addressing learner-Centred barriers to sexuality education in rural areas of South Africa: learners' perspectives on promoting sexual health outcomes","volume":"20","author":"Adekola","year":"2023","journal-title":"Sex Res Social Policy"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1080\/14681811.2020.1749044","article-title":"College students\u2019 suggestions for improving sex education in schools beyond \u2018blah blah blah condoms and STDs\u2019","volume":"21","author":"Astle","year":"2020","journal-title":"Sex Education"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"e0002650","DOI":"10.1371\/journal.pgph.0002650","article-title":"Perceptions of youth-friendly sexual and reproductive health services in selected higher and tertiary education institutions of Zambia: a qualitative study on the perspectives of young people and healthcare providers","volume":"3","author":"Jacobs","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1665","DOI":"10.1007\/s10508-022-02504-3","article-title":"Perceptions, experiences, and needs of adolescents about school-based sexual health education: qualitative systematic review","volume":"52","author":"Shorey","year":"2023","journal-title":"Arch Sex Behav"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1911945\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:28:03Z","timestamp":1787549283000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1911945\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":43,"alternative-id":["10.3389\/fpubh.2026.1911945"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1911945","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"1911945"}}