School-based HIV prevention programme increases knowledge about condoms, procurement of contraception and reduces intimate partner violence among young adolescents Cluster randomized controlled trial in Western Cape, South Africa.

Catherine Mathews, Sander Matthijs Eggers, Loraine Townsend, Leif Edvard Aarø, Petrus J de Vries, Amanda Jayne Mason-Jones, Petra De Koker, Tracy Mclinton Appolis, Joy Koech, Yolisa Mtshizana, Annegreet Wubs, Tracy Naledi, Hein De Vries

Research output: Contribution to conferenceAbstractpeer-review


Background: Unwanted pregnancies and sexually transmitted infections, including HIV, are among the social and health consequences of early adolescent sexual debut and unprotected sex. We evaluated the effects of a multi-component, school-based HIV prevention intervention to delay sexual debut and increase condom use (primary outcomes), decrease IPV, and increase access to condoms, contraception and HIV tests (secondary outcomes) among young adolescents in the Western Cape, South Africa.
Methods: During 2013-2014 we conducted a cluster RCT among Grade 8 students in 42 randomly selected public high schools. After agreeing to participate, schools were randomly allocated to intervention or comparison arms. In intervention schools we implemented a 21-session after-school sexual health educational programme, school health service and school sexual violence prevention programme. Comparison schools had usual care. Participants completed questionnaires at baseline,
6 and 12 months. Regression was undertaken to provide outcomes at 6 and 12 months with ORs for dichotomous variables and coefficients for continuous variables, adjusted for baseline demographics, the baseline measure in question and clustering.
Results: One school dropped out before data collection. Of 6244 sampled adolescents in 41 schools, 3451 (55.3%) had signed parental consent and assented to participate. Retention at 12 months was 87.6%. In the intervention arm 614 participants (33.6%) attended at least 50% of educational sessions and 16.0% used the health service. At 12 months, there were no differences between arms in one year incidence of sexual debut (10.4% versus 9.3%; OR= 1.09; 95% CI: 0.81-1.44), condom use at last sex (74.1% versus 80.3%; OR: 0.70, CI: 0.30-1.63), procurement of condoms or HIV tests. Participants in the intervention arm (versus comparison arm) had better knowledge (mean: 0.49, SD: 0.24 versus mean: 0.43, SD: 0.22; Beta: 0.06; CI: 0.03-0.09), were less likely to report IPV (34.6% versus 39.7%; OR: 0.77, CI: 0.61-0.99) and were more likely to have accessed contraception (24.8% versus 18.7%; OR: 1.47; CI: 1.12-1.92). Stronger effects were obtained among participants who attended more sessions.
Conclusions: The intervention may not have changed some sexual behaviours, but may have led to less violent sexual relationships and lower risk of unwanted pregnancy. We need effective ways to improve intervention uptake.
Original languageEnglish
Publication statusPublished - 19 Jul 2015
EventIAS 2015. 8th IAS Conference on HIV pathogenesis, treatment and prevention. - Vancouver, Canada
Duration: 19 Jul 201522 Jul 2015


ConferenceIAS 2015. 8th IAS Conference on HIV pathogenesis, treatment and prevention.

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