To understand the impact of COVID-19 on the implementation of the peer education programme of the National Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram (RKSK); repurposing of the RKSK health workers and Peer Educators (PEs) in COVID-19 response activities and effect on adolescents´ health and development issues. Virtual in-depth interviews were conducted with stakeholders (n=31) (aged 15 to 54 years) engaged in the implementation of the RKSK and peer education programme at state, district, block, and village levels in Madhya Pradesh and Maharashtra (India). These interviews were thematically coded and analysed to address the research objectives. Despite most peer education programme activities being stopped, delayed, or disrupted during the pandemic and subsequent lockdown, some communication networks previously established, helped facilitate public health communication regarding COVID-19 and RKSK, between health workers, PEs, and adolescents. There was repurposing of RKSK health workers and PEs’ role towards COVID-19 response-related activities. PEs, with support from health workers, were involved in disseminating COVID-19 information, maintaining migrant and quarantine records, conducting household surveys for recording COVID-19 active cases and providing essential items (grocery, sanitary napkins, etc.) to communities and adolescents.India is home to 243 million adolescents, yet there is a lack of data on several health indicators and no national data on the current levels of knowledge, perceptions, and practices of adolescents. In 2014, the Ministry of Health and Family Welfare (MOHFW), Government of India (GOI) launched a comprehensive National Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram (RKSK), to emphasize community-based health promotion and strengthening preventive, diagnostic and curative service across health system related to 6 strategic priorities. RKSK interventions, which include a Peer Educator (PE) Programme component, are being implemented in a phased manner; the first phase targets 213 selected High Priority Districts in 28 states of India. The PE programme is designed to provide life skills, increase knowledge and awareness among PEs and adolescents of their needs under six strategic priorities, and the availability of services and care at Adolescent Friendly Health Clinics (AFHC), which should lead to increased adolescents' attendance at AFHCs. The year 2020 has experienced an unprecedented pandemic (COVID-19), intensely affecting millions of people, including adolescents (10-19 years). The study's objective is to explore the implementation of the Peer Educator Intervention for improving adolescent health in India's National Adolescent Health Programme during COVID-19 (i-Saathiya). Aims: Research Aim 1: Describe the process of implementation, and context of the PE Programme under the RKSK during COVID-19, in two Indian states. Research Aim 2: Understand peer educators’ engagement during the COVID-19 pandemic and adolescents’ response to PE engagement in the community and accessing the health system. Research Aim 3: Understand the resource use and implementation cost of peer educator programme and their variations across two states of India. Research Aim 4: Identify key components of PE intervention that work to improve health system access and community engagement of adolescents during COVID-19 for informing and building back better response and for scaling up (Research to Policy and program action) of adolescent health programmes in other states of India. A mixed methods cross-sectional study was conducted in the two states Madhya Pradesh and Maharashtra. Data was collected quantitatively through surveys, routine program data, and qualitatively through in-depth interviews, focus group discussions, and semi-structured observations. As part of this larger study, before commencing data collection a situational analysis was undertaken in the two Indian states (Madhya Pradesh and Maharashtra) from June-October, 2020, with the relevant stakeholders involved in the RKSK/PE programme.

To mitigate the risk of COVID-19 transmission, virtual semi-structured in-depth interviews were conducted with stakeholders (n=31) engaged in the implementation of the RKSK and peer education programme at state, district, block, and village levels in two Indian States. A snowball sampling technique was used to recruit the study participants. IDIs were moderated by trained researchers accompanied by a note taker. These interviews were conducted in English or Hindi and audio-recorded. Interviews were translated and transcribed verbatim by members of the research team.