With the PACK Adult programme forming a valued role in the current Western Cape primary health care system, and the development of the PACK Child guide, it became apparent that there was a lack of clinical guidance for adolescent patients in the primary care setting. To fully realise a life-course approach, the KTU developed a proposal to develop and pilot PACK Adolescent with a view to PACK Child covering care from birth to age 9, PACK Adolescent from 10 to 19 (in line with the WHO definition of adolescence) and PACK Adult from 20 years onwards. Work on the guide began in May 2017 with funding from the Global Fund and support from the Western Cape Department of Health. A key partner in the development process was the Desmond Tutu Health Foundation in the context of their work to support better adolescent wellbeing.
The PACK Adolescent guide covers the comprehensive integrated care of a 10-19 year old in the primary healthcare setting and follows the standard PACK approach and style. We paid particular attention to refining content to reflect specific adolescent health care priorities like sexual and reproductive health, mental health and substance abuse. We established a Guide Development Advisory Group to represent adolescent health priorities, inform the scope of the guide and ensure adequate stakeholder representation in its development. External review of draft content to ensure accuracy and applicability to the setting for which it is intended was conducted. In addition, multidisciplinary clinical working groups were convened to resolve content issues for various sections: genitourinary, pregnancy, contraception, nutrition, musculoskeletal, HIV and TB. These groups comprised specialist and primary care clinicians, allied health professionals, representatives of patient advocacy groups and the provincial Department of Health Adolescent and Youth Friendly Services (AYFS) Programme and other stakeholders involved in the delivery of adolescent and youth friendly primary care services.
A complete draft of the PACK Adolescent Guide was completed on 1 June 2018. This guide is fully functional and integrated and the majority of the content has been externally reviewed during clinical working groups or via electronic feedback. Some content still requires external review, including mental health, palliative care, DR-TB and epilepsy. Work on associated training materials has not yet occurred and there are no current implementation plans. Additional funding and support is needed to complete guide review, develop training materials and implement and evaluate the programme.