Effects of PREPARE a Multicomponent SchoolBase

Authors: Catherine Mathews Sander M Eggers Loraine Townsend Leif E Aarø Petrus J de Vries Amanda J MasonJones Petra De Koker Tracy McClinton Appollis Yolisa Mtshizana Joy Koech Annegreet Wubs Hein De Vries

Publish Date: 2016/05/03

Volume: 20, Issue: 9, Pages: 1821-1840

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Abstract

Young South Africans especially women are at high risk of HIV We evaluated the effects of PREPARE a multicomponent schoolbased HIV prevention intervention to delay sexual debut increase condom use and decrease intimate partner violence IPV among young adolescents We conducted a cluster RCT among Grade eights in 42 high schools The intervention comprised education sessions a school health service and a school sexual violence prevention programme Participants completed questionnaires at baseline 6 and 12 months Regression was undertaken to provide ORs or coefficients adjusted for clustering Of 6244 sampled adolescents 553  participated At 12 months there were no differences between intervention and control arms in sexual risk behaviours Participants in the intervention arm were less likely to report IPV victimisation 351 vs 409  OR 077 95  CI 061–099 t40 = 214 suggesting the intervention shaped intimate partnerships into safer ones potentially lowering the risk for HIVGlobally HIV is ranked second among the leading causes of death among adolescents 1 Among adolescents and youth in South Africa there has been little progress in preventing new infections Although declining somewhat the HIV prevalence and incidence among young South Africans 15–24 years remains high especially among women 2 3 4 In the Western Cape South Africa the setting of this study HIV is still the leading cause of premature mortality http//wwwmrcacza/bod/WC2010Reportpdf and adolescents commonly report an early sexual debut and unprotected sex 5 These behaviours increase the risk of sexually transmitted infections STI including HIVIn South Africa adolescents’ intimate relationships are marked by a high incidence of violence 6 Sexual violence and intimate partner violence IPV increase the risk of STIs including HIV among women 7 This implies that to be effective HIV prevention interventions should include a focus on preventing sexual violence and IPV In the Western Cape and Limpopo provinces of South Africa cluster RCTs of schoolbased HIV prevention interventions without a focus on IPV failed to demonstrate an impact on the timing of sexual debut or condom use among the younger adolescent participants average age 13 years and also failed to impact on IPV 5 However in the Eastern Cape a communitybased HIV and IPV prevention programme for adolescents 16 years and older which included a substantial focus on IPV showed a beneficial impact on STI incidence and male IPV perpetration 8In our cluster randomised controlled trial PREPARE conducted among young adolescents average age 13 years in the Western Cape we evaluated an HIV prevention programme that included a focus on IPV and sexual violence reduction In the current trial we tested the hypothesis that the PREPARE programme would 1 delay sexual debut 2 increase the use of condoms 3 decrease the number of sexual partners among young adults A secondary objective was to assess the effect of the intervention on IPV and not reported here the threeyear incidence of conceptions among female participants

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