INTRODUCTION:
adolescent girls and young women (agyw) in uganda continue to experience high rates of hiv infection, tuberculosis (tb), and sexual and reproductive health (srh) challenges. access barriers such as stigma, cost, and distance limit facility-based care. uganda development and health associates (udha), in partnership with the aids support organisation (taso), implemented a community-based safe-space primary health care (phc) model to integrate hiv, tb, and srh services. this study evaluates the model’s effectiveness in improving service uptake and linkage to care among agyw aged 15–24 years in eastern uganda.

METHODS:
a cross-sectional analysis was conducted using data from january 2024 to june 2025 across nine districts. each safe-space session offered integrated hiv testing, pre-exposure prophylaxis (prep), family planning, tb screening, and gender-based violence support delivered by trained peer facilitators and clinicians. quantitative data were extracted from outreach registers and dhis2 summaries, while qualitative data from focus groups explored acceptability and behavioral change.

RESULTS:
a total of 15284 agyw accessed services during 312 safe-space sessions. hiv testing coverage reached 98 percent, with 93 percent receiving same-day results and 82 percent of positives linked to treatment within 72 hours. prep uptake rose from 7 to 21 percent, while 4217 initiated family planning. 6302 agyw underwent tb screening, identifying 212 presumptive cases for genexpert testing. participants reported increased trust, peer motivation, and reduced stigma compared to facility-based care.

CONCLUSIONS:
the safe-space phc model demonstrates that community-anchored service delivery can significantly enhance access, continuity, and quality of hiv, tb, and srh services for young women. scaling the model through district health systems could advance universal health coverage and gender-responsive health equity in uganda.