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Lassi ZS, Rahim KA, Stavropoulos AM, Ryan LM, Tyagi J, Adewale B, Kurji J, Bhaumik S, Meherali S, Ali M. Use of contraceptives, empowerment and agency of adolescent girls and young women: a systematic review and meta-analysis. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2023-202151. [PMID: 38479786 DOI: 10.1136/bmjsrh-2023-202151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/19/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The evidence on adolescent empowerment, which involves access to personal and material resources for reproductive autonomy and economic equity, is limited. This systematic review assesses the use of contraceptives in empowering and strengthening the agency and vice versa among adolescents and young women. METHODS We ran the searches in six electronic databases: Cochrane Database of Systematic Reviews (CDSR) and the Cochrane Central Register of Controlled Trials (CENTRAL), The Campbell Library, MEDLINE (PubMed), EMBASE, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Web of Science. The methodological quality of studies was assessed using ROBINS-I and ROB-II tools as appropriate. Meta-analysis was performed using Review Manager 5.4. RESULTS Forty studies that assessed the impact of empowerment on contraceptive use were included. Of these, 14 were non-randomised studies for intervention (NRSIs), and the remaining 26 were randomised controlled trials (RCTs). The results from RCTs show a significant effect of the sexual and reproductive health empowerment in increasing ever use of contraception (RR 1.22; 95% CI 1.02, 1.45; n=9; I²=77%; GRADE: Very Low), and insignificant effect on unprotected sex (RR 0.97; 95% CI 0.74, 1.26; n=5; I²=86%; GRADE: Very Low) and adolescent pregnancy (RR 1.07; 95% CI 0.61, 1.87; n=3; I²=36%; GRADE: Very Low). None of the studies assessed impact of contraceptive use on empowerment. CONCLUSIONS Empowerment of adolescents and young women certainly improves contraceptive use in the immediate or short-term period. However, more robust studies with low risk of bias, longer-term outcomes, and impact of contraceptive use on empowerment and agency-strengthening are required. To increase contraceptive use uptake, tailored policies and delivery platforms are necessary for youth in low- and middle-income countries.
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Affiliation(s)
- Zohra S Lassi
- School of public health, Faculty of health and medical sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Komal Abdul Rahim
- Dean's Office, Medical College, Aga Khan University, Karachi, Pakistan
- Center of Excellence in Trauma and Emergencies, Aga Khan University, Karachi, Pakistan
| | | | - Lareesa Marie Ryan
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jyoti Tyagi
- George Institute of Global Health, New Delhi, India
| | - Bisi Adewale
- University of Alberta, Edmonton, Alberta, Canada
| | - Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Soumyadeep Bhaumik
- Meta-Research and Evidence Synthesis Unit, Health Systems Science, George Institute of Global Health, New Delhi, India
- George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia
| | | | - Moazzam Ali
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
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Brazete C, Caveiro D, Neto ML, Dinis JP, Rocha LC, Sá L, Carvalhido R. Validation of a Questionnaire on Sexual and Reproductive Health Among Immigrant Vocational Education Students in Portugal from São Tomé and Príncipe. J Community Health 2023; 48:847-856. [PMID: 37160528 PMCID: PMC10469261 DOI: 10.1007/s10900-023-01230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
Sexual and reproductive health interventions' effectiveness should be evaluated using a valid instrument. This study aimed to validate a questionnaire on sexual and reproductive health in adolescents and young adults from São Tomé and Príncipe who voluntarily enrolled in a vocational school in Portugal to complete their 12th school year and obtain a professional card.A questionnaire consisting of perception and knowledge sections was adapted from previous questionnaires. We followed the steps of psychometric analysis. Firstly, we assessed face validity and content validity. We used factorial analysis to validate the perceptions section (which included Likert-type questions). For the knowledge section (which consisted of multiple-choice questions), we used the key check, discrimination index, and difficulty index. We evaluated internal consistency through Cronbach's alpha for the perceptions section and the Kuder-Richardson score for the knowledge section.Out of 105 invited students, a total of ninety students were enrolled in this study, of whom 88 completed most of the questions. The exploratory analysis showed that most students agreed with the right to refuse intercourse. However, while approximately 23% disagreed that consensual sex among adult women or men is always wrong, around the same proportion agreed. A considerable number of students recognized condoms and pills as effective methods of contraception. However, most students were unfamiliar with other methods. Most knowledge questions showed acceptable difficulty levels, and the discrimination index varied among questions. The knowledge questions demonstrated good consistency levels. This study enabled us to develop an appropriate instrument for evaluating the effectiveness of public health interventions and identifying specific knowledge gaps in migrant populations from low-income countries. This will help prioritise topics to be addressed in sexual health education sessions.
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Affiliation(s)
- Cátia Brazete
- Unidade Local de Saúde do Alto Minho, Unidade de Saúde Pública, Viana do Castelo, Portugal.
- Universidade do Porto, Instituto de Saúde Pública, Porto, Portugal.
| | - Diogo Caveiro
- Unidade Local de Saúde do Alto Minho, Unidade de Saúde Pública, Viana do Castelo, Portugal
- Universidade do Porto, Instituto de Saúde Pública, Porto, Portugal
| | - Marisa Lopes Neto
- Unidade Local de Saúde do Alto Minho, Unidade de Saúde Pública, Viana do Castelo, Portugal
| | - João Pedro Dinis
- Unidade Local de Saúde do Alto Minho, Unidade de Saúde Pública, Viana do Castelo, Portugal
| | - Luís Castro Rocha
- Unidade Local de Saúde do Alto Minho, Unidade de Saúde Pública, Viana do Castelo, Portugal
| | - Lígia Sá
- Unidade Local de Saúde do Alto Minho, Unidade de Saúde Pública, Viana do Castelo, Portugal
| | - Ricardo Carvalhido
- SWITCH ON - Academia de Formação Profissional, Viana do Castelo, Portugal
- Escola Superior de Educação, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
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Musindo O, Jafry S, Nyamiobo J, Becker KD, Gellatly R, Maloy C, Lozano-Ruiz A, Romero-Gonzalez B, Kola L, Merali Z, Chorpita BF, Kumar M. Mental health and psychosocial interventions integrating sexual and reproductive rights and health, and HIV care and prevention for adolescents and young people (10-24 years) in sub-Saharan Africa: a systematic scoping review. EClinicalMedicine 2023; 57:101835. [PMID: 36874395 PMCID: PMC9981905 DOI: 10.1016/j.eclinm.2023.101835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 12/14/2022] [Accepted: 01/09/2023] [Indexed: 02/24/2023] Open
Abstract
Background Interventions targeting combined sexual and reproductive health, Human Immunodeficiency Virus (HIV) management and mental health care in sub-Saharan Africa (SSA) are few. There is a need to address common determinants of poor mental, psychosocial and sexual and reproductive health and rights (SRHR) through multimodal and multipronged interventions for adolescents. The main objective of this study was to identify whether and how interventions targeting adolescent SRHR and HIV with a focus on pregnant and parenting adolescents in SSA include mental health components and how these components and their outcomes have been reported in the literature. Methods We carried out a two process scoping review approach between 01.04.2021 and 23.08.2022. In the first stage, we searched the PubMed database to identify studies focusing on adolescents and young people aged 10 to 24 from 2001 to 2021. We identified studies focusing on HIV and SRHR that had mental health and psychosocial aspects to the interventions. Our search yielded 7025 studies. Of these 38 were eligible based on our screening criteria that covered interventions, and on further scrutiny, using PracticeWise, an established coding system, we identified select problems and practices to provide a more granular assessment of how interventions developed for this context mapped on to specific problems. At this second stage process, we selected 27 studies for inclusion as actual interventional designs for further systematic scoping of their findings and we used the Joanna Briggs Quality Appraisal checklist to rate these studies. This review was registered within the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42021234627. Findings Our first set of findings is that when coding problems and solutions, mental health concerns were the least common category of problems targeted in these SRHR/HIV interventions; nevertheless, psychoeducation and cognitive behavioral strategies such as improved communication, assertiveness training, and informational support were offered widely. Of the 27 interventional studies included in the final review, 17 RCTs, 7 open trials, and 3 mixed designs, represented nine countries of the 46 countries in SSA. Intervention types included peer, community, family, digital, and mixed modality interventions. Eight interventions focused on caregivers and youth. Social or community ecology associated problems (being an orphan, sexual abuse, homelessness, negative cultural norms) were the most common risk factors and were more frequent than medical issues associated with HIV exposure. Our findings highlight the relevance and centrality of social issues related to adolescent mental and physical health along with the need to strengthen multimodal interventions along the lines of problems we have identified in our review. Interpretation Combined interventions jointly addressing adolescent SRHR, HIV, and mental health have been relatively understudied, despite evidence that adverse social and community factors are rampant in this population. Funding MK was funded by Fogarty International CenterK43 TW010716-05 and lead the initiative.
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Affiliation(s)
- Otsetswe Musindo
- Department of Clinical, Neuro- & Developmental Psychology, Vrije University, Amsterdam, Netherlands
| | - Sheharbano Jafry
- Department of Global Health, University of Washington Seattle, USA
| | - Joseph Nyamiobo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Kimberly D. Becker
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Resham Gellatly
- Department of Psychology, University of California, Los Angeles, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Caitlin Maloy
- Health Sciences Library, University of Washington Seattle, USA
| | - Alvaro Lozano-Ruiz
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Borja Romero-Gonzalez
- Department of Psychology, Faculty of Education, University of Valladolid, Valladolid, Spain
| | - Lola Kola
- Department of Psychiatry, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Zul Merali
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Bruce F. Chorpita
- Department of Psychology, University of California, Los Angeles, USA
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
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Ghazi HF, Taher TMJ, Hassan MR. Systematic review on effectiveness of prevention programs for sexually transmitted diseases (STD). J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Debele GR, Tsegaye D, Gemechu T, Siraj SZ. Influences of parental monitoring and school connectedness on age at first sexual debut among unmarried female youth in Bedele town, Ethiopia: A survival analysis of timing using accelerated failure time model. PLoS One 2022; 17:e0271906. [PMID: 35881614 PMCID: PMC9321400 DOI: 10.1371/journal.pone.0271906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background The age of first sexual debut among youth continues to attract interest as it marks the start of their exposure to a variety of sexual and reproductive health problems. Parental monitoring (PM) and school connectedness (SC) has been found to have an effect on this problem. Despite this fact, there is a dearth of literature on implications of PM and SC on age at first sexual debut in Ethiopia. Therefore, this paper examined the influences of PM and SC age at first sexual debut among female youth. Methods A retrospective follow-up study was conducted on 470 randomly selected female youth in Bedele town, Oromia regional state, southwest Ethiopia from February 1 to March 30, 2021. The age at first sexual debut was asked in full years for respondents who ever engaged in sexual debut at a time of data collection. Data were entered using Epi-Data version 4.6 and analyzed using Stata version 14. All variables at P-values less than 0.2 in bivariable analysis were exported to multivariable analysis. Multivariable Accelerated Failure Time (AFT) regression analyses using Weibull distribution were used to examine the association of age at first sexual debut with PM and SC at 5% level of significance. Results Overall, 132(28.1%) youths were begun sexual activities of which 79.54% was an early (vaginal penetrative sex before 18 years old). The incidence rate was 15.58/1000 PY with 95% CI of [13.14, 18.47]. The result shows that, female youth start first sexual debut as early as 10 year and mean age was 16.89±2.82. Only 27.97% of those who began sexual debut used contraception during first sex. Multivariable Weibull AFT regression analyses adjusted for different variables showed that high PM (Adjusted Time Ratio (ATR) 1.13: 95%CI; [1.04, 1.21]) and good SC (ATR: 1.14: 95% CI; [1.06, 1.22] significantly delays the age at first sexual debut. Conclusions Overall, four out of every five premarital sexual activities were early sexual debuts. High PM and high SC significantly decrease early sexual debut by delaying the age of sexual initiation. Therefore, family and school involvement focused on PM and SC of the youth is recommended as an important mechanism for preventing youths’ risky sexual behaviour, including early sexual debut.
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Affiliation(s)
- Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
- * E-mail:
| | - Dereje Tsegaye
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | | | - Sabit Zenu Siraj
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
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Mudhune V, Sabben G, Ondenge K, Mbeda C, Morales M, Lyles RH, Arego J, Ndivo R, Bednarczyk RA, Komro K, Winskell K. The Efficacy of a Smartphone Game to Prevent HIV Among Young Africans: Protocol for a Randomized Controlled Trial in the Context of COVID-19. JMIR Res Protoc 2022; 11:e35117. [PMID: 35030090 PMCID: PMC8896564 DOI: 10.2196/35117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescents contribute slightly less than one-third of all new HIV infections in sub-Saharan Africa. There is a need for more effective intervention approaches to help young adolescents safely navigate through adolescence and into adulthood. We are assessing the efficacy of Tumaini, a smartphone game designed to prevent HIV among young Africans. Against the background of COVID-19, meaningful alteration of the research protocol was necessary to ensure successful implementation and retention of the study participants in ongoing research. OBJECTIVE The objective of our protocol is to determine (1) if Tumaini delays sexual debut and increases condom use at first sex and (2) whether it influences behavioral mediators of early and unprotected sex. METHODS Participants were recruited from Kisumu County in Western Kenya. This study is a 2-arm, individual-randomized controlled trial that enrolled 1004 adolescents aged between 12 years and 15 years. The intervention arm participants are playing Tumaini, while the control arm is provided with Brainilis, a commercially available control game. The study period will last 45 months. At baseline, participants in both arms completed a baseline survey and biological testing for HIV and herpes simplex virus, type 2 (HSV-2); participants will have annual game play periods in years 1-3. They will also complete a total of 12 follow-up surveys. At endline, repeat biological testing will be conducted. Protocol adaptations were necessitated by the COVID-19 pandemic and implemented in accordance with local public health guidelines. RESULTS Participants were enrolled between October 2020 and November 2020. We plan to complete study procedures in September 2024. The enrolled participant sample was 50.1% (499/996) female and had a mean age of 14.0 (SD 0.6) years. CONCLUSIONS This ongoing research demonstrates that, with appropriate revisions to planned protocol activities guided by the need to maintain study integrity, protect both study participants and staff, and adhere to institutional review board and local health authority guidelines, human subject research is possible in the context of a global pandemic. If the trial demonstrates efficacy, Tumaini would provide an alternative, remote means of delivering age-appropriate education to adolescents on safer sex, HIV prevention, and effective life skills on a highly scalable, low-cost, and culturally adaptable platform. TRIAL REGISTRATION ClinicalTrials.gov NCT04437667; https://clinicaltrials.gov/ct2/show/NCT04437667. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/35117.
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Affiliation(s)
- Victor Mudhune
- HIV Research Division, Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Gaëlle Sabben
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Ken Ondenge
- HIV Research Division, Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Calvin Mbeda
- HIV Research Division, Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Marissa Morales
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Robert H Lyles
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Judith Arego
- HIV Research Division, Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Richard Ndivo
- HIV Research Division, Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Kelli Komro
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Arthur K, Christofides N, Nelson G. Process evaluation of a pre-adolescent transdisciplinary health intervention for inter-generational outcomes. PLoS One 2021; 16:e0261632. [PMID: 34941911 PMCID: PMC8699635 DOI: 10.1371/journal.pone.0261632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background The CIrCLE of Life Initiative was implemented to 537 grade 6 learners and their parents, in five Government-run South African primary schools. The transdisciplinary intervention was intended to increase knowledge and skills on HIV and obesity. The study aim was to assess and report on the implementation process. Methods Data was collected on an adapted Proctor’s taxonomy of implementation outcomes, and to assess participants’ experiences. Qualitative and quantitative data were collected through educator logbooks, researcher observations, and learner-parent workbooks. Results Differentiations between the various school contexts were observed. The process evaluation revealed high learner penetration (97.2%), but lower learner and parent exposure (44.3% and 55.5%, respectively). All educators thought that the intervention was a fit for both rural and urban schools, different socio-economic groups, and people of different ethnic and cultural backgrounds. The intervention was perceived to be sustainable, and there were recommendations for adoption into the school curriculum and scale-up if found to be effective. Conclusion The process evaluation facilitated the assessment of the implementation outcomes, described its processes, and acknowledged fundamental characteristics that could justify variability in the intervention impact and outcomes. The value of process evaluations and their benefit to the science of implementation were demonstrated.
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Affiliation(s)
- Keshni Arthur
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gill Nelson
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- UCL Institute for Global Health, University College London, London, United Kingdom
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Arthur K, Christofides N, Nelson G. Effectiveness of a pre-adolescent inter-generational intervention to address HIV and obesity in South Africa, using a pretest-posttest design. BMC Public Health 2021; 21:2251. [PMID: 34895196 PMCID: PMC8665511 DOI: 10.1186/s12889-021-12228-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/13/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Strengthening pre-adolescents knowledge and skills through an age- and culturally-appropriate intervention could prevent health issues later in life. Early interventions could influence the trajectory of future risky behaviour, and may influence health behaviour amongst their parents. The CIrCLE of Life Initiative was developed to address HIV and obesity. We evaluated whether the combined intervention increased knowledge, enhanced skills, and/or promoted healthy behaviour among students (9-12 years old) and their parents. METHODS The study was conducted from May to December 2018. Trained educators delivered 30-min lessons over ten consecutive weeks with 537 Grade 6 students at five government-run schools, in a district, in South Africa. Schools were purposively selected based on socioeconomic status and urban-rural classification. Students communicated with parents through shared homework activities. A pretest-posttest study design was used, with a 3-month follow up. Both groups completed self-administered paper-based questionnaires. A score of subscales was used in analysis. The pretest and posttest scores were compared for students and parents using a dependent t-test. Differences in outcomes by school quintile were compared using one-way ANOVA. RESULTS Response rates were high for both students (80.6%) and their parents (83.4%). Statistically significant differences were observed in HIV knowledge in students pretest (mean 8.04, SD 3.10) and posttest scores (mean 10.1, SD 2.70; p < 0.01), and their parents (mean 10.32, SD 2.80 vs 11.0, SD 2.50; p < 0.01). For both students and parents, pre- and post-test obesity awareness mean scores were similar, 1.93, SD 0.92 and 2.78, SD 0.57; p < 0.01, for students; and 2.47, SD 0.82 and 2.81, SD 0.54; p < 0.01, for parents. In the posttest, statistically significant changes were also observed in both groups, enhancing skills in measuring body mass index and pulse rate, and interpreting food labels. Students had a high intention to share gained knowledge with parents who had a high intention to receive it (89.4 and 89.5%, respectively). CONCLUSION The intervention increased knowledge about HIV and obesity-related awareness, and it enhanced skills in selected outcomes among pre-adolescents and parents. Accurate messages and enhanced communication skills could support inter-generational knowledge transfer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04307966 retrospectively registered on 12 March 2020.
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Affiliation(s)
- Keshni Arthur
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Nicola Christofides
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Gill Nelson
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
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Shangase N, Kharsany ABM, Ntombela NP, Pettifor A, McKinnon LR. A Systematic Review of Randomized Controlled Trials of School Based Interventions on Sexual Risk Behaviors and Sexually Transmitted Infections Among Young Adolescents in Sub-Saharan Africa. AIDS Behav 2021; 25:3669-3686. [PMID: 33772695 DOI: 10.1007/s10461-021-03242-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/29/2022]
Abstract
Young adolescents in Sub-Saharan Africa (SSA) are at high risk of involvement in sexual risk behaviors; and curable sexually transmitted infections (STI), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV) and unintended pregnancies remain persistently high in this population. Evidence based strategies are urgently needed to improve these outcomes. The aim of this systematic review was to synthesize the evidence from randomized controlled trials (RCT) to determine whether school-based interventions promote safe sex behaviors, reduce sexual risk behaviors and risk of curable STIs, HSV-2, HIV and unintended pregnancies among young adolescents aged 9-19 years in SSA. Electronic databases were searched for published studies and manual searches were conducted through reviewing of references of cited literature in the English language up to December 2019. Two independent reviewers screened and abstracted the data. We identified 428 articles and data from nine RCTs (N = 14,426 secondary school students) that fulfilled the selection criteria were analysed. Two studies measured pregnancy as an outcome and showed significant declines in unintended pregnancies. Of the five studies that measured HIV/AIDS related-knowledge, condom-use outcomes (normative beliefs, knowledge, and self-efficacy) and attitudes to HIV testing, four showed significant improvements. Of the six studies that measured sexual debut, four reported moderate but non-significant declines and in two studies sexual debut information was either incomplete or unreliable. One study measured curable STIs and found no significant declines; whilst the second study that measured HSV-2 and HIV, no significant declines were observed. This review highlights the need to undertake well-designed research studies to provide evidence on the impact of interventions on curable STIs, HSV-2 and HIV, critical to improving the health of young adolescents.
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Affiliation(s)
- Nosipho Shangase
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 2106 McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599-7435, USA
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.
- School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Nonzwakazi P Ntombela
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Audrey Pettifor
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Lyle R McKinnon
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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Lassi ZS, Kedzior SGE, Tariq W, Jadoon Y, Das JK, Bhutta ZA. Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low- and middle-income countries: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1156. [PMID: 37131925 PMCID: PMC8356350 DOI: 10.1002/cl2.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background The preconception period is an ideal time to introduce interventions relating to nutrition and other lifestyle factors to ensure good pregnancy preparedness, and to promote health of mothers and babies. In adolescents, malnutrition and early pregnancy are the common challenges, particularly among those who live in low- and middle-income countries (LMIC) where 99% of all maternal and newborn deaths occur. These girls receive little or no attention until their first pregnancy and often the interventions after pregnancy are too late to revert any detrimental health risks that may have occurred due to malnutrition and early pregnancy. Objectives To synthesise the evidence of the effectiveness of preconception care interventions relating to delayed age at first pregnancy, optimising inter-pregnancy intervals, periconception folic acid, and periconception iron-folic acid supplementation on maternal, pregnancy, birth and child outcomes. Search Methods Numerous electronic databases (e.g., CINAHL, ERIC) and databases of selected development agencies or research firms were systematically searched for all available years up to July 2019. In addition, we searched the reference lists of relevant articles and reviews, and asked experts in the area about ongoing and unpublished studies. Selection Criteria Primary studies, including large-scale programme evaluations that assessed the effectiveness of interventions using randomised controlled trials (RCTs) or quasi-experimental designs (natural experiments, controlled before-after studies, regression discontinuity designs, interrupted time series [ITS]), that targeted women of reproductive age (i.e., 10-49 years) during the pre- and periconceptional period in LMICs were included. Interventions were compared against no intervention, standard of care or placebo. Data Collection and Analysis Two or more review authors independently reviewed searches, selected studies for inclusion or exclusion, extracted data and assessed risk of bias. We used random-effects model to conduct meta-analyses, given the diverse contexts, participants, and interventions, and separate meta-analyses for the same outcome was performed with different study designs (ITS, RCTs and controlled before after studies). For each comparison, the findings were descriptively summarised in text which included detailing the contextual factors (e.g., setting) to assess their impact on the implementation and effectiveness of each intervention. Main Results We included a total of 43 studies; two of these were included in both delaying pregnancy and optimising interpregnancy intervals resulting in 26 studies for delaying the age at first pregnancy (14 RCTs, 12 quasi-experimental), four for optimising interpregnancy intervals (one RCT, three quasi-experimental), five on periconceptional folic acid supplementation (two RCTs, three quasi-experimental), and 10 on periconceptional iron-folic acid supplementation (nine RCTs, one quasi-experimental). Geographically, studies were predominantly conducted across Africa and Asia, with few studies from North and Central America and took place in a combination of settings including community, schools and clinical. The education on sexual health and contraception interventions to delay the age at first pregnancy may make little or no difference on risk of unintended pregnancy (risk ratio [RR], 0.42; 95% confidence internal [CI], 0.07-3.26; two studies, =490; random-effect; χ 2 p .009; I 2 = 85%; low certainty of evidence using GRADE assessment), however, it significantly improved the use of condom (ever) (RR, 1.54; 95% CI, 1.08-2.20; six studies, n = 1604; random-effect, heterogeneity: χ 2 p .004; I 2 = 71%). Education on sexual health and and provision of contraceptive along with involvement of male partneron optimising interpregnancy intervals probably makes little or no difference on the risk of unintended pregnancies when compared to education on sexual health only (RR, 0.32; 95% CI, 0.01-7.45; one study, n = 45; moderate certainty of evidence using GRADE assessments). However, education on sexual health and contraception intervention alone or with provision of contraceptive showed a significant improvement in the uptake of contraceptive method. We are uncertain whether periconceptional folic acid supplementation reduces the incidence of neural tube defects (NTDs) (RR, 0.53; 95% CI, 0.41-0.77; two studies, n = 248,056; random-effect; heterogeneity: χ 2 p .36; I 2 = 0%; very low certainty of evidence using GRADE assessment). We are uncertain whether preconception iron-folic acid supplementation reduces anaemia (RR, 0.66; 95% CI, 0.53-0.81; six studies; n = 3430, random-effect; heterogeneity: χ 2 p < .001; I 2 = 88%; very low certainty of evidence using GRADE assessment) even when supplemented weekly (RR, 0.70; 95% CI, 0.55-0.88; six studies; n = 2661; random-effect; heterogeneity: χ 2 p < .001; I 2 = 88%; very low certainty of evidence using GRADE assessments),and in school set-ups (RR, 0.66; 95% CI, 0.51-0.86; four studies; n = 3005; random-effect; heterogeneity: χ 2 p < .0001; I 2 = 87%; very low certainty of evidence using GRADE assessment). Data on adverse effects were reported on in five studies for iron-folic acid, with the main complaint relating to gastrointestinal side effects. The quality of evidence across the interventions of interest was variable (ranging from very low to moderate) which may be attributed to the different study designs included in this review. Concerning risk of bias, the most common concerns were related to blinding of participants and personnel (performance bias) and whether there were similar baseline characteristic across intervention and comparison groups. Authors' Conclusions There is evidence that education on sexual health and contraception interventions can improve contraceptive use and knowledge related to sexual health, this review also provides further support for the use of folic acid in pregnancy to reduce NTDs, and notes that weekly regimes of IFA are most effective in reducing anaemia. However the certainty of the evidence was very low and therefore more robust trials and research is required, including ensuring consistency for reporting unplanned pregnancies, and further studies to determine which intervention settings (school, community, clinic) are most effective. Although this review demonstrates promising findings, more robust evidence from RCTs are required from LMICs to further support the evidence.
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Affiliation(s)
- Zohra S. Lassi
- Robinson Research InstituteUniversity of AdelaideAdelaideAustralia
| | - Sophie G. E. Kedzior
- Faculty of Health and Medical Sciences, Robinson Research InstituteUniversity of AdelaideAdelaideAustralia
| | | | - Yamna Jadoon
- Department of PaediatricsAga Khan University HospitalKarachiPakistan
| | - Jai K. Das
- Division of Women and Child HealthAga Khan University HospitalKarachiPakistan
| | - Zulfiqar A. Bhutta
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoCanada
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Maina BW, Juma K, Igonya EK, Osindo J, Wao H, Kabiru CW. Effectiveness of school-based interventions in delaying sexual debut among adolescents in sub-Saharan Africa: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e044398. [PMID: 34020975 PMCID: PMC8144038 DOI: 10.1136/bmjopen-2020-044398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/12/2021] [Accepted: 04/23/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Early sexual debut is associated with poor sexual and reproductive health outcomes across the life course. A majority of interventions aimed at delaying sexual debut among adolescents in sub-Saharan Africa (SSA) have been implemented in schools with mixed findings on the effectiveness of such interventions. This systematic review will summarise and synthesise existing evidence on the effectiveness of school-based interventions in delaying sexual debut among adolescents aged 10-19 years. METHODS AND ANALYSIS We will conduct a comprehensive database search of peer-reviewed studies published in PubMed, Scopus, Science Direct, Web of Science, HINARI and EBSCO (PsycINFO, Global Health, CINAHL) and in Cochrane library, National Institute of Health and Turning Research into Practice databases for ongoing studies yet to be published. All studies conducted in SSA between January 2009 and December 2020, regardless of the study design, will be included. Two authors will independently screen all retrieved records and relevant data on sexual debut extracted.Data will be pooled using the random effects model. Dichotomous outcomes will be reported as risk ratios and continuous data as mean difference at 95% CI. Heterogeneity will be assessed using the I² statistic. Findings will be presented in tables and charts, while providing a description of all included studies, themes and concepts drawn from literature. ETHICS AND DISSEMINATION Ethical approval is not required. The findings will be disseminated through peer-reviewed publications, presentations at relevant conferences and other convening focusing on adolescent sexual and reproductive health.
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Affiliation(s)
- Beatrice W Maina
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
- School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Kenneth Juma
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
| | - Emmy Kageha Igonya
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
| | - Jane Osindo
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Hesborn Wao
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline W Kabiru
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
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Asuquo SE, Tahlil KM, Muessig KE, Conserve DF, Igbokwe MA, Chima KP, Nwanunu EC, Elijah LP, Day S, Rosenberg NE, Ong JJ, Nkengasong S, Tang W, Obiezu‐Umeh C, Nwaozuru U, Merino Y, Gbaja‐Biamila T, Oladele D, Iwelunmor J, Ezechi O, Tucker JD. Youth engagement in HIV prevention intervention research in sub-Saharan Africa: a scoping review. J Int AIDS Soc 2021; 24:e25666. [PMID: 33569913 PMCID: PMC7876473 DOI: 10.1002/jia2.25666] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/20/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Youth engagement in HIV research is generally recognized as essential, but often neglected or minimally implemented in practice. Engagement is a process of working collaboratively with diverse groups of people to address common issues. We conducted a scoping review of youth HIV prevention interventions in sub-Saharan Africa to identify and categorize forms and levels of youth engagement across the lifespan of intervention research. METHODS We followed Arksey and O'Malley's framework for organizing a scoping review. We searched seven databases for related articles on identified intervention studies through May 28th 2020. Included studies focused on youth (10 to 24 years old) HIV prevention interventions in sub-Saharan Africa. Two reviewers independently examined citations and full manuscripts for inclusion. Data were extracted on study characteristics, location, description of youth engagement and extent of engagement. Youth engagement approaches were categorized based on Hart's ladder as substantial engagement (strong youth decision-making power), moderate engagement (shared decision making with adults), minimal engagement (no youth decision-making power) or no engagement. RESULTS We identified 3149 citations and included 112 studies reporting on 74 unique HIV interventions. Twenty-two interventions were in low-income countries, 49 in middle-income countries, and three were in both. Overall, only nine interventions (12%) had substantial or moderate youth engagement, two-thirds (48, 65%) had minimal youth engagement and 17 interventions (23%) had no youth engagement. We also identified specific engagement strategies (e.g. youth-led research, crowdsourcing) that were feasible in multiple settings and resulted in substantial engagement. CONCLUSIONS We found limited youth engagement in youth HIV prevention intervention studies in sub-Saharan Africa. However, several activities resulted in substantial youth engagement and could be relevant in many low-and-middle-income-country (LMIC) settings.
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Affiliation(s)
- Sarah E Asuquo
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kadija M Tahlil
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kathryn E Muessig
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Donaldson F Conserve
- Department of Health Promotion, Education, and BehaviorArnold School of Public HealthUniversity of South CarolinaColumbiaSCUSA
| | - Mesoma A Igbokwe
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineUniversity of NigeriaNsukkaNigeria
| | - Kelechi P Chima
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineUniversity of NigeriaNsukkaNigeria
| | - Ezienyi C Nwanunu
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- Department of BiochemistryMichael Okpara University of AgricultureUmudikeNigeria
| | - Lana P Elijah
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
- College of MedicineLagos State UniversityLagosNigeria
| | - Suzanne Day
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Nora E Rosenberg
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
- University of North Carolina Project MalawiLilongweMalawi
| | - Jason J Ong
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
- Central Clinical SchoolMonash UniversityMelbourneVic.Australia
| | - Susan Nkengasong
- Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineLondonUK
| | - Weiming Tang
- Dermatology HospitalSouthern Medical UniversityGuangzhouChina
| | - Chisom Obiezu‐Umeh
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Yesenia Merino
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - David Oladele
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health EducationSaint Louis UniversitySaint LouisMOUSA
| | - Oliver Ezechi
- Clinical Sciences DepartmentNigerian Institute of Medical ResearchLagosNigeria
| | - Joseph D Tucker
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
- Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
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How Sexuality Education Programs Have Been Evaluated in Low-and Lower-Middle-Income Countries? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218183. [PMID: 33167481 PMCID: PMC7664002 DOI: 10.3390/ijerph17218183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 01/25/2023]
Abstract
Background: Complex sexual and reproductive health interventions, such as sexuality education (SE), contain multiple components and activities, which often requires a comprehensive evaluation design and adaptation to a specific context. In this review, we synthetize available scientific literature on types of evaluation designs used for SE programs in low- and lower-middle-income countries. Methods: Two databases yielded 455 publications, from which 20 articles met the inclusion criteria. Narrative synthesis was used to summarize the findings. Evaluation approaches were compared to recommended evaluation frameworks. The quality of articles was assessed by using MMAT 2018. Results: A total of 15 interventions employed in 10 countries were evaluated in the 20 selected articles, with the quality of publications being moderate to high. Randomized controlled trial was the predominant study design, followed by quasi-experimental design. There were seven process evaluation studies, using mixed methods. Main outcomes reported were of public health or behavioral nature—condom use, sexual debut or delay, and number of sexual partners. By comparing evaluation designs to recommended frameworks, few studies fulfilled at least half of the criteria. Conclusions: Evaluations of SE are largely dominated by quantitative (quasi-)experimental designs and use of public health outcomes. To improve understanding of SE program effectiveness, it is important to assess the quality of the program development, its implementation, and its impact, using existing evaluation frameworks and recommendations.
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Barriers and Facilitators to Engaging African American Men Who Have Sex With Men in the HIV Care Continuum: A Theory-Based Qualitative Study. J Assoc Nurses AIDS Care 2020; 30:352-361. [PMID: 31021964 DOI: 10.1097/jnc.0000000000000087] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
African American men who have sex with men (MSM) have high rates of HIV, but interventions are needed to address their low rates of engagement in the HIV care continuum. To identify modifiable factors potentially affecting such engagement, we conducted qualitative interviews guided by the Theory of Planned Behavior with 27 African American MSM who had participated in an HIV risk-reduction intervention trial. Qualitative analyses resulted in four overarching themes: stigma, concerns with health care providers (HCPs), social support, and logistical issues. Facilitators of care continuum engagement included reassurance about health, feeling and looking better, receiving treatment, avoiding infecting others, good relations with HCP, and social support. Barriers included HIV stigma, concerns about confidentiality, negative perceptions of HCP, convenience and availability of testing/treatment facilities, cost, and lack of social support. Efforts to improve African American MSM HIV care continuum engagement should focus on individual and health care system changes.
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Shafii T, Benson SK, Morrison DM. Brief Motivational Interviewing Delivered by Clinician or Computer to Reduce Sexual Risk Behaviors in Adolescents: Acceptability Study. J Med Internet Res 2019; 21:e13220. [PMID: 31293242 PMCID: PMC6652122 DOI: 10.2196/13220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/05/2019] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinicians are expected to screen their adolescent patients for an increasing number of health behaviors and intervene when they uncover risky behaviors, yet, the clinic time allotted to screen, intervene, and provide resources is insufficient. Brief motivational interviewing (MI) offers succinct behavior change counseling; however, for implementation, clinicians need training, skill, and time. Computerized screening and counseling adjuvants may help clinicians increase their scope of behavioral screening, especially with sensitive topics such as sexual health, and provide risk-reduction interventions without consuming provider time during visits. OBJECTIVE The objectives of this study were to (1) understand the extent to which health care providers use brief MI for sexual health discussions with adolescent patients and (2) assess the acceptability of incorporating a brief MI-based intervention to reduce sexual risk behaviors into their clinical practice delivered by either themselves or a computer. METHODS At a national medical conference, surveys were administered to clinicians who provide sexual health care to adolescents. They were asked about their current use of MI for sexual risk behavior discussions and their willingness to implement computerized sexual health screening and computerized sexual risk behavior interventions into their clinical practice. RESULTS The large majority (87.6%, 170/194) of clinicians already used MI with their patients with less than half (72/148, 48.6%) reporting they had been formally trained in MI. Despite all (195/195, 100.0%) clinicians feeling very or completely comfortable discussing sexual risk behaviors with their patients, the large majority (160/195, 82.1%) reported it would be useful, very useful, or extremely useful for a computerized program to do it all: screen their patients, generate risk profiles, and provide the risk-reduction counseling rather than doing it themselves. CONCLUSIONS In this study, most clinicians used some form of brief MI or client-centered counseling when discussing sexual risk behaviors with adolescents and are very comfortable doing so. However, the large majority would prefer to implement computerized sexual health screening, risk assessment, and sexual risk behavior interventions into their clinical care of adolescents.
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Affiliation(s)
- Taraneh Shafii
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Samantha K Benson
- Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, United States
| | - Diane M Morrison
- School of Social Work, University of Washington, Seattle, WA, United States
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Catalano RF, Skinner ML, Alvarado G, Kapungu C, Reavley N, Patton GC, Jessee C, Plaut D, Moss C, Bennett K, Sawyer SM, Sebany M, Sexton M, Olenik C, Petroni S. Positive Youth Development Programs in Low- and Middle-Income Countries: A Conceptual Framework and Systematic Review of Efficacy. J Adolesc Health 2019; 65:15-31. [PMID: 31010725 DOI: 10.1016/j.jadohealth.2019.01.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Positive youth development (PYD) has served as a framework for youth programs in high-income countries since the 1990s and has demonstrated broad behavioral health and developmental benefits. PYD programs build skills, assets, and competencies; foster youth agency; build healthy relationships; strengthen the environment; and transform systems to prepare youth for successful adulthood. The goal of this article was to systematically review the impact of PYD programs in low- and middle-income countries (LMICs). METHODS Targeted searches of knowledge repository Web sites and keyword searches of Scopus and PubMed identified over 21,500 articles and over 3,700 evaluation reports published between 1990 and mid-2016. Ninety-four PYD programs with evaluations in LMICs were identified, of which 35 had at least one experimental or rigorous quasi-experimental evaluation. RESULTS Sixty percent of the 35 programs with rigorous evaluations demonstrated positive effects on behaviors, including substance use and risky sexual activity, and/or more distal developmental outcomes, such as employment and health indicators. CONCLUSIONS There is promising evidence that PYD programs can be effective in LMICs; however, more rigorous examination with long-term follow-up is required to establish if these programs offer benefits similar to those seen in higher income countries.
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Affiliation(s)
- Richard F Catalano
- The Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington
| | - Martie L Skinner
- The Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington.
| | | | | | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - George C Patton
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Cassandra Jessee
- International Center for Research on Women, Washington, DC; Making Cents International, Washington, DC
| | | | | | - Kristina Bennett
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Meroji Sebany
- International Center for Research on Women, Washington, DC
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Jemmott JB, O’Leary A, Jemmott LS, Ngwane ZP, Teitelman AM, Makiwane MB, Bellamy SL. Effect of a Behavioral Intervention on Perpetrating and Experiencing Forced Sex Among South African Adolescents: A Secondary Analysis of a Cluster Randomized Trial. JAMA Netw Open 2018; 1:e181213. [PMID: 30646113 PMCID: PMC6324287 DOI: 10.1001/jamanetworkopen.2018.1213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Scant research has investigated interventions to reduce forced sexual intercourse among adolescents. The need for such interventions is especially great in South Africa, which has some of the highest rates of sexual assault in the world. OBJECTIVES To determine whether an HIV/sexually transmitted disease risk-reduction intervention that reduced sexual risk behavior and sexually transmitted disease prevalence also reduced the perpetration and experience of forced sex among South African adolescents. DESIGN, SETTING, AND PARTICIPANTS A cluster randomized clinical trial, at schools located in a township and a semirural area, Eastern Cape Province, South Africa. Matched pairs of schools were randomly selected (9 of 17); of 1118 students in sixth grade at these 18 schools who had parent or guardian consent, 1057 (94%) were enrolled, and those not reporting forced sex perpetration before the intervention were included in the analyses (n = 1052). Post hoc secondary analysis of a cluster randomized clinical trial was performed, with baseline and 3-, 6-, 12-, 42-, and 54-month postintervention assessments between October 4, 2004, and June 30, 2010. Generalized estimating equation Poisson regression analyses adjusting for gender and clustering within schools were conducted between August 23, 2017, and April 30, 2018. Recruiters and data collectors, but not intervention facilitators, were blind to the participants' intervention assignment. INTERVENTIONS Theory-based, culturally adapted, 6-session HIV/sexually transmitted disease risk-reduction intervention (Let Us Protect Our Future intervention) and attention-matched, chronic disease prevention control intervention implemented by specially trained man and woman cofacilitators from the community. MAIN OUTCOMES AND MEASURES Study outcomes for this secondary analysis (planned after the data were collected) are self-reports of perpetrating and experiencing forced vaginal intercourse. RESULTS Participants included 1052 adolescents (557 girls [53%]; mean [SD] age, 12.4 [1.2] years) reporting not perpetrating forced sex at baseline. Fewer intervention than control participants reported forced sex perpetration postintervention compared with the control group at 3 months (9 of 561 [2%] vs 20 of 491 [4%]; risk ratio [RR], 0.978; 95% CI, 0.959-0.997), 6 months (17 of 561 [3%] vs 35 of 491 [7%]; RR, 0.964; 95% CI, 0.941-0.988), 12 months (21 of 561 [4%] vs 42 of 491 [9%]; RR, 0.959; 95% CI, 0.934-0.985), 42 months (41 of 561 [7%] vs 56 of 491 [11%]; RR, 0.967; 95% CI, 0.937-0.998), and 54 months (52 of 561 [9%] vs 68 of 491 [14%]; RR, 0.964; 95% CI, 0.932-0.997). CONCLUSIONS AND RELEVANCE In settings with high rates of sexual assault, the use of theory-based culturally adapted interventions with early adolescents may reduce rates of perpetrating and experiencing forced sex. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00559403.
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Affiliation(s)
- John Barton Jemmott
- Annenberg School for Communication, Center for Health
Behavior and Communication Research, University of Pennsylvania, Philadelphia
- University of Pennsylvania, Philadelphia
| | - Ann O’Leary
- Centers for Disease Control and Prevention, Atlanta,
Georgia
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Winskell K, Sabben G, Akelo V, Ondeng'e K, Obong'o C, Stephenson R, Warhol D, Mudhune V. A Smartphone Game-Based Intervention (Tumaini) to Prevent HIV Among Young Africans: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e10482. [PMID: 30068501 PMCID: PMC6094086 DOI: 10.2196/10482] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/01/2018] [Accepted: 06/19/2018] [Indexed: 12/05/2022] Open
Abstract
Background There is a pressing need to ensure that youth in high HIV prevalence settings are prepared for a safer sexual debut. Smartphone ownership is increasing dramatically in low-income and middle-income countries. Smartphone games that are appropriately grounded in behavioral theory and evidence-based practice have the potential to become valuable tools in youth HIV prevention efforts in Sub-Saharan Africa. Objective To pilot-test a theory-based, empirically grounded smartphone game for young Kenyans designed to increase age and condom use at first sex, aiming to establish directionality of effects on behavior change. Methods Tumaini (“hope for the future” in Swahili) is an interactive, narrative-based game grounded in social cognitive theory. A randomized controlled pilot study was conducted in Kisumu, Western Kenya, from April to June 2017 with 60 participants aged 11-14 (mean 12.7) years. Intervention arm participants (n=30) were provided with an Android smartphone with Tumaini installed on it and were instructed to play the game for at least 1 hour a day for 16 days; control arm participants (n=30) received no intervention. All participants completed a survey on behavioral mediators, delivered via an audio computer-assisted self-interview system at baseline (T1), post intervention (T2), and at 6 weeks postintervention (T3). The postintervention survey for intervention arm participants included questions eliciting feedback on the game. Intervention arm participants and their parents participated in 8 postintervention focus group discussions. Game log files were analyzed to calculate the length of exposure to the game. Behavioral survey data were analyzed using two-sample t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. Descriptive statistics on game feedback questions were computed. Focus group transcripts were uploaded to MAXQDA software, where they were labeled with deductive and inductive codes. Data were analyzed thematically and compared across demographics. Results Intervention arm participants played Tumaini for a mean of approximately 27 hours. The intervention arm showed significant gains in sexual health-related knowledge and self-efficacy (both P<.001), behavioral intention for risk-avoidance strategies and sexual risk communication (P=.006), and overall survey scores (P<.001) compared with the control arm at T3. The postintervention survey revealed high subjective measures of the game’s value, relevance, and appeal. Focus groups identified a wide range of knowledge and skills the participants had gained, including setting goals and planning how to achieve them, which was perceived as a key motivator for avoiding or reducing risk. Conclusions The study supports the need for further research to assess the efficacy of the game-based intervention. If proven efficacious, smartphone games have the potential to dramatically increase the reach of culturally adapted behavioral interventions while ensuring fidelity to intervention design. Trial Registration ClinicalTrials.gov NCT03054051; http://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW)
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Affiliation(s)
- Kate Winskell
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Gaëlle Sabben
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Victor Akelo
- Kenya Medical Research Institute- Centre for Global Health Research, HIV Research Branch, Kisumu, Kenya
| | - Ken Ondeng'e
- Kenya Medical Research Institute- Centre for Global Health Research, HIV Research Branch, Kisumu, Kenya
| | | | - Rob Stephenson
- School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - David Warhol
- Realtime Associates, El Segundo, CA, United States
| | - Victor Mudhune
- Kenya Medical Research Institute- Centre for Global Health Research, HIV Research Branch, Kisumu, Kenya
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O'Leary A. Women and HIV in the Twenty-First Century: How Can We Reach the UN 2030 Goal? AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:213-224. [PMID: 29969306 DOI: 10.1521/aeap.2018.30.3.213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Women have always been part of the HIV/AIDS epidemic. As with other populations affected by HIV, for many years the only prevention strategy available was behavior change. Behavioral interventions for women were developed and evaluated, with some success. Because women did not control the use of male condoms, efficacious interventions needed to build skills for partner negotiation. Woman-controlled technologies such as the female condom and vaginal spermicide were unable to solve the problem of male control of the condom and enable the development of safe methods for women to protect themselves. The modern era of HIV prevention has produced biomedical solutions based on highly active retroviral chemoprophylaxis, which can be hidden from the male partner and thus eliminate his possible negative reactions. Pre-exposure prophylaxis holds promise for HIV prevention among women. This article reviews the literature on HIV prevention for women, including both successes and challenges.
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Affiliation(s)
- Ann O'Leary
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Closson K, Dietrich JJ, Lachowsky NJ, Nkala B, Palmer A, Cui Z, Beksinska M, Smit JA, Hogg RS, Gray G, Miller CL, Kaida A. Sexual Self-Efficacy and Gender: A Review of Condom Use and Sexual Negotiation Among Young Men and Women in Sub-Saharan Africa. JOURNAL OF SEX RESEARCH 2018; 55:522-539. [PMID: 29466024 DOI: 10.1080/00224499.2017.1421607] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexual self-efficacy (SSE), one's perceived control of or confidence in the ability to perform a given sexual outcome, predicts sexual behavior; however, important questions remain regarding whether gender modifies observed associations. In a comprehensive review of peer-reviewed HIV-prevention literature focusing on youth (ages 10 to 25) in sub-Saharan Africa, we measured and assessed the influence of SSE on condom use and sexual refusal, overall and by gender. Our results, after reviewing 63 publications, show that SSE is inconsistently measured. Most studies measured condom use self-efficacy (CUSE) (96.8%) and/or sexual refusal self-efficacy (SRSE) (63.5%). On average, young men had higher CUSE than young women, while young women had higher SRSE than young men. While cross-sectional studies reported an association between high SSE and sexual behaviors, this association was not observed in interventions, particularly among young women who face a disproportionate risk of HIV acquisition. In all, 25% of intervention studies demonstrated that fostering CUSE increased condom use among young men only, and one of two studies demonstrated that higher SRSE led to reduced frequency of sexual activity for both men and women. Future research and HIV-prevention interventions must be gender targeted, consider improving CUSE for young men, and move beyond limited individual-level sexual behavior change frameworks.
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Affiliation(s)
- Kalysha Closson
- a Faculty of Health Sciences , Simon Fraser University
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Janan J Dietrich
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
| | - Nathan J Lachowsky
- b British Columbia Centre for Excellence in HIV/AIDS
- d School of Public Health and Social Policy , University of Victoria
| | - Busiwe Nkala
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
- e Faculty of Humanities , University of the Witwatersrand
| | - Alexis Palmer
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Zishan Cui
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Mags Beksinska
- f MatCH Research Unit [Maternal, Adolescent and Child Health Research Unit], Faculty of Health Sciences, University of the Witwatersrand
| | - Jennifer A Smit
- f MatCH Research Unit [Maternal, Adolescent and Child Health Research Unit], Faculty of Health Sciences, University of the Witwatersrand
| | - Robert S Hogg
- a Faculty of Health Sciences , Simon Fraser University
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Glenda Gray
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
| | - Cari L Miller
- a Faculty of Health Sciences , Simon Fraser University
| | - Angela Kaida
- a Faculty of Health Sciences , Simon Fraser University
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Icard LD, Jemmott JB, Carty C, O'Leary A, Sidloyi L, Hsu J, Tyler J, Martinez O. Retention of South African Adolescents in a 54-Month Longitudinal HIV Risk Reduction Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 18:534-540. [PMID: 28508155 DOI: 10.1007/s11121-017-0793-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Retention of participants in clinical trials is a central concern of HIV/STI behavioral researchers and research sponsors. This article describes the strategies used for addressing the challenges in retaining South African adolescents for a 54-month longitudinal study. The objective of the South African adolescent health promotion long-term follow-up trial was to test the sustainability of the effects of an HIV/STI risk reduction intervention, "Let Us Protect Our Future," on young adolescents as they aged into middle and late adolescence. Inaccurate contact information, invalid mobile telephone numbers, lack of transportation, transitory family addresses, and family relocation were among the challenges to retaining participants. Despite a significant gap in time of 36 months between the main trial and the long-term follow-up study, 99.2% of 1057 participants were retained. Solutions used for retaining the adolescents are discussed with suggestions offered for retaining adolescents in longitudinal HIV/STI prevention clinical trials in low resource countries.
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Affiliation(s)
- Larry D Icard
- College of Public Health, School of Social Work, Temple University, Philadelphia, PA, 19122, USA.
| | - John B Jemmott
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Craig Carty
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Ann O'Leary
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lulama Sidloyi
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Hsu
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - JoAnn Tyler
- Department of Statistics, University of Fort Hare, Alice, South Africa
| | - Omar Martinez
- College of Public Health, School of Social Work, Temple University, Philadelphia, PA, 19122, USA
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Zhang J, Jemmott JB, Icard LD, Heeren GA, Ngwane Z, Makiwane M, O'Leary A. Predictors and psychological pathways for binge drinking among South African men. Psychol Health 2018; 33:810-826. [PMID: 29415576 DOI: 10.1080/08870446.2018.1429613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To develop targeted interventions for high-risk drinkers among South African men, we assessed whether sociodemographic factors and history of childhood sexual abuse predicted binge drinking at six-month follow-up assessment and their psychological pathways according to the extended Theory of Reasoned Action (TRA). DESIGN Survey responses with a sample of 1181 South African men from randomly selected neighbourhoods in Eastern Cape Province were collected at baseline and six-month follow-up. Multiple logistic regression analysis examined the baseline predictors of binge drinking. Serial multiple mediation analysis examined the psychological pathways. MAIN OUTCOME MEASUREMENTS Binge drinking at six-month follow-up. RESULTS Age (OR = 1.03, 95% CI: 1.01, 1.05), religious participation (OR = .73, CI: .65, .82) and history of childhood sexual abuse (OR = 1.82, CI: 1.32, 2.51) were significant predictors of binge drinking. Predictions of religious participation and history of childhood sexual abuse were partially mediated through attitude, subjective norm, descriptive norm and intention to binge drinking. CONCLUSION South African men with childhood sexual abuse experience and low religious participation were at higher risk for binge drinking. The extended TRA model explains the associations of these factors to binge drinking and can contribute to the design and evaluation of interventions.
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Affiliation(s)
- Jingwen Zhang
- a Department of Communication , University of California , Davis , CA , USA
| | - John B Jemmott
- b Department of Psychiatry , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA.,c Annenberg School for Communication , University of Pennsylvania , Philadelphia , PA , USA
| | - Larry D Icard
- d College of Health Professions and Social Work , Temple University , Philadelphia , PA , USA
| | - G Anita Heeren
- b Department of Psychiatry , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Zolani Ngwane
- e Department of Anthropology , Haverford College , Haverford , PA , USA
| | - Monde Makiwane
- f Human Sciences Research Council , Pretoria , South Africa
| | - Ann O'Leary
- g Centers for Disease Control and Prevention , Atlanta , GA , USA
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Yu J, Zhang Y, Jiang J, Lu Q, Liang B, Liu D, Fang K, Huang J, He Y, Ning C, Liao Y, Lai J, Wei W, Qin F, Ye L, Geng W, Liang H. Implementation of a "County-Township-Village" Allied HIV Prevention and Control Intervention in Rural China. AIDS Patient Care STDS 2017; 31:384-393. [PMID: 28891716 DOI: 10.1089/apc.2017.0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In China, rural areas are a weak link of HIV/AIDS prevention and control. From September 2011, an innovative "county-township-village" allied intervention was implemented in Longzhou County, Guangxi, which assigned the tasks of HIV/AIDS prevention and control to the county Centers for Disease Control and Prevention (CDC), township hospitals, and village clinics, respectively, instead of traditional intervention in which the county CDC undertook the entire work. A 6-year consecutive cross-sectional survey, including 3-year traditional intervention (2009-2011) and 3-year innovative intervention (2012-2014), was conducted to evaluate the effects of the new intervention. Compared to traditional intervention, the innovative intervention achieved positive effects in decreasing risky behaviors. Among female sex workers, condom use rate in the last month increased from 72.06% to 96.82% (p < 0.01). Among drug users, having commercial sex rate in the last year reduced from 17.20% to 5.94% and condom use rate increased from 14.06% to 76.09% (p < 0.01). The risk ratio of HIV infection during innovative intervention was 0.631 (95% confidence interval 0.549-0.726) compared with traditional one. Cost-effectiveness analysis indicates that innovative intervention restores each disability-adjusted life year costing an average of $124.26. Taken together, Longzhou's innovative intervention has achieved good effects on HIV/AIDS prevention and control and provides a good reference for rural China.
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Affiliation(s)
- Jun Yu
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Yi Zhang
- Department of AIDS Prevention, Longzhou Center for Disease Control and Prevention, Longzhou County, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Qinglin Lu
- Department of AIDS Prevention, Guangxi Health and Family Planning Commission, Nanning, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Deping Liu
- Department of AIDS Prevention, Chongzuo Center for Disease Control and Prevention, Chongzuo, China
| | - Keyong Fang
- Department of AIDS Prevention, Longzhou Center for Disease Control and Prevention, Longzhou County, China
| | - Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Yang He
- Department of AIDS Prevention, Longzhou Center for Disease Control and Prevention, Longzhou County, China
| | - Chuanyi Ning
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Collaborative Innovation Center for Biomedicine, Life Science Institute, Guangxi Medical University, Nanning, China
| | - Yanyan Liao
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Collaborative Innovation Center for Biomedicine, Life Science Institute, Guangxi Medical University, Nanning, China
| | - Jingzhen Lai
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Wudi Wei
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Fengxiang Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Wenkui Geng
- Department of AIDS Prevention, Guangxi Health and Family Planning Commission, Nanning, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Collaborative Innovation Center for Biomedicine, Life Science Institute, Guangxi Medical University, Nanning, China
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24
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Zhang J, Jemmott JB, Heeren GA. Sub-Saharan African University Students' Beliefs about Abstinence, Condom Use, and Limiting the Number of Sexual Partners. Behav Med 2017; 43:9-20. [PMID: 25864861 DOI: 10.1080/08964289.2015.1028321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Given the high risk of HIV infection among university students in sub-Saharan Africa, there is a need for culturally appropriate risk-reduction interventions specifically targeting this population. Efforts to reduce the risk require an understanding of the modifiable antecedents of sexual-risk behaviors. We report the results of a semi-structured elicitation survey based on the reasoned action approach to identify behavioral, normative, and control beliefs regarding abstinence, condom use, and limiting sexual partners. Two coders classified into 64 belief categories the written responses of 96 sub-Saharan African university students. Most students believed each behavior could reduce risk of HIV infection. The students reported that peer pressure and being in a risky environment made it harder to practice abstinence. Good communication made it easier to use condoms and to limit partners; however, unstable relationships made practicing these protective behaviors harder. The identified beliefs help to inform the development of theory-based HIV risk-reduction interventions.
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Affiliation(s)
- Jingwen Zhang
- a Annenberg School for Communication, University of Pennsylvania
| | - John B Jemmott
- a Annenberg School for Communication, University of Pennsylvania.,b Perelman School of Medicine, University of Pennsylvania
| | - G Anita Heeren
- b Perelman School of Medicine, University of Pennsylvania
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25
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Sani AS, Abraham C, Denford S, Ball S. School-based sexual health education interventions to prevent STI/HIV in sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health 2016; 16:1069. [PMID: 27724886 PMCID: PMC5057258 DOI: 10.1186/s12889-016-3715-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/23/2016] [Indexed: 11/18/2022] Open
Abstract
Background School-based sexual health education has the potential to provide an inclusive and comprehensive approach to promoting sexual health among young people. We reviewed evaluations of school-based sexual health education interventions in sub-Saharan Africa to assess effectiveness in reducing sexually transmitted infections and promoting condom use. Methods We searched ten electronic databases, hand-searched key journals, and reference lists of included articles for potential studies. Data were extracted on outcomes, intervention characteristics, methods and study characteristics indicative of methodological quality. Where possible, data were synthesized using random effect meta-analysis. Intervention features found predominantly in effective interventions were noted. Results The initial search retrieved 21634 potentially relevant citations. Of these, 51 papers reporting on 31 interventions were included. No evaluation reported statistically significant effects on the incidence or prevalence of Human Immunodeficiency Virus and Herpes Simplex Virus 2 infections. However, intervention participants reported statistically significant greater condom use in both randomised controlled trials and non-randomised trials for short (less than 6 months) follow-up periods (OR = 1.62, 95 % CI = 1.03–2.55 and OR = 2.88, 95 % CI = 1.41–5.90 respectively). For intermediate (6–10 months) and long-term (more than 10 months) follow-up periods, the effect was statistically significant (OR = 1.40, 95 % CI = 1.16–1.68) and marginally significant (OR = 1.22, 95 % CI = 0.99–1.50) among the randomised trials respectively. Only 12 of the 31 interventions reported implementation details, out of which seven reported on fidelity. Conclusion School-based sexual health education has the potential to promote condom use among young people in sub-Saharan Africa. However, further work is needed to develop and evaluate interventions that have measurable effects on sexually transmitted infections. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3715-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Sadiq Sani
- Psychology Applied To Health, University of Exeter Medical School, College House, St Lukes Campus, Exeter, EX1 2 LU, UK.
| | - Charles Abraham
- Psychology Applied To Health, University of Exeter Medical School, College House, St Lukes Campus, Exeter, EX1 2 LU, UK
| | - Sarah Denford
- Psychology Applied To Health, University of Exeter Medical School, College House, St Lukes Campus, Exeter, EX1 2 LU, UK
| | - Susan Ball
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2 LU, UK
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Salam RA, Faqqah A, Sajjad N, Lassi ZS, Das JK, Kaufman M, Bhutta ZA. Improving Adolescent Sexual and Reproductive Health: A Systematic Review of Potential Interventions. J Adolesc Health 2016; 59:S11-S28. [PMID: 27664592 PMCID: PMC5026684 DOI: 10.1016/j.jadohealth.2016.05.022] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/14/2016] [Accepted: 06/24/2016] [Indexed: 01/08/2023]
Abstract
Adolescents have special sexual and reproductive health needs (whether or not they are sexually active or married). This review assesses the impact of interventions to improve adolescent sexual and reproductive health (including the interventions to prevent female genital mutilation/cutting [FGM/C]) and to prevent intimate violence. Our review findings suggest that sexual and reproductive health education, counseling, and contraceptive provision are effective in increasing sexual knowledge, contraceptive use, and decreasing adolescent pregnancy. Among interventions to prevent FGM/C, community mobilization and female empowerment strategies have the potential to raise awareness of the adverse health consequences of FGM/C and reduce its prevalence; however, there is a need to conduct methodologically rigorous intervention evaluations. There was limited and inconclusive evidence for the effectiveness of interventions to prevent intimate partner violence. Further studies with rigorous designs, longer term follow-up, and standardized and validated measurement instruments are required to maximize comparability of results. Future efforts should be directed toward scaling-up evidence-based interventions to improve adolescent sexual and reproductive health in low- and middle-income countries, sustain the impacts over time, and ensure equitable outcomes.
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Affiliation(s)
- Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anadil Faqqah
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Nida Sajjad
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Miriam Kaufman
- Division of Adolescent Medicine, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.
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Kalamar AM, Bayer AM, Hindin MJ. Interventions to Prevent Sexually Transmitted Infections, Including HIV, Among Young People in Low- and Middle-Income Countries: A Systematic Review of the Published and Gray Literature. J Adolesc Health 2016; 59:S22-31. [PMID: 27562450 DOI: 10.1016/j.jadohealth.2016.05.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/26/2016] [Accepted: 05/26/2016] [Indexed: 11/17/2022]
Abstract
Sexually transmitted infections (STIs), including HIV, are prevalent among adolescents and can have lasting adverse health consequences. The objective of this review is to identify high-quality interventions and evaluations to decrease STI transmission and related risky behaviors among young people in low- and middle-income countries. PubMed, Embase, PsycInfo, Cinahl Plus, Popline, and the Cochrane Databases were searched without language limitations for articles published through November 2015. Gray literature was searched by hand. Reference tracing was utilized, as well as the unpacking of systematic reviews. Retained articles were those that were evaluated as having high-quality interventions and evaluations using standardized scoring. Twenty-one high-quality interventions and evaluations were abstracted. Three reported declines in STI diagnoses, three reported declines in STI symptoms, six showed declines in risky sexual behavior, seven reported increases in abstinence, 11 found increases in condom use, and five reported increases in health care utilization. There is a wide range of rigorously evaluated high-quality interventions included in this review that can inform researchers, donors, and policy makers about where to make strategic investments to decrease the spread of STIs, including HIV. With the recent advent of biomarkers, researchers can use a gold standard measure to assess intervention impact. The diversity of interventions can allow decision makers to tailor interventions to the context, age range, and gender of the target population.
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Affiliation(s)
- Amanda M Kalamar
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Angela M Bayer
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michelle J Hindin
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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28
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Espada JP, Escribano S, Morales A, Orgilés M. Two-Year Follow-Up of a Sexual Health Promotion Program for Spanish Adolescents. Eval Health Prof 2016; 40:483-504. [PMID: 27307056 DOI: 10.1177/0163278716652217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim is to evaluate the effects of the Competencias para adolescentes con una sexualidad saludable (COMPAS) program and compare them with an evidence-based program ( ¡Cuídate!) and a control group (CG). Eighteen public high schools were randomly assigned to one of the three experimental conditions. Initially, 1,563 Spanish adolescents between 14 and 16 years of age participated, and 24 months after their implementation, 635 of them completed a survey. Self-report measures collected data on sexual behavior, knowledge, attitudes, intention, sexual risk perception, and perceived norm. Compared to the CG, COMPAS increased the level of knowledge about sexually transmitted infections and improved the attitudes toward people living with human immunodeficiency virus at the 2-year follow-up. Neither intervention had a long-term impact on behavioral variables. Results suggest that COMPAS has a comparable impact to the other intervention on the variables predicting consistent condom use. Reinforcing the messages and skills that have the greatest impact on condom use and adding booster sessions following program completion as strategies to maintain long-term effects are necessary.
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Affiliation(s)
- Jose P Espada
- 1 Deparment of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Silvia Escribano
- 1 Deparment of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Alexandra Morales
- 1 Deparment of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Mireia Orgilés
- 1 Deparment of Health Psychology, Miguel Hernández University, Elche, Spain
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29
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Teitelman AM, Jemmott JB, Bellamy SL, Icard LD, O'Leary A, Heeren GA, Ngwane Z, Ratcliffe SJ. Partner violence, power, and gender differences in South African adolescents' HIV/sexually transmitted infections risk behaviors. Health Psychol 2016; 35:751-760. [PMID: 27111184 DOI: 10.1037/hea0000351] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Low relationship power and victimization by intimate partner violence (IPV) have been linked to HIV risks among adult and adolescent women. This article examines associations of IPV and relationship power with sexual-risk behaviors and whether the associations differ by gender among South African adolescents. METHOD Sexual-risk behaviors (multiple partners in past 3 months; condom use at last sex), IPV, and relationship power were collected from 786 sexually experienced adolescents (mean age = 16.9) in Eastern Cape Province, South Africa, during the 54-month follow-up of a HIV/sexually transmitted infection (STI) risk-reduction intervention trial. The data were analyzed with logistic regression models. RESULTS Adolescent boys were less likely to report condom use at last sex (p = .001) and more likely to report multiple partners (p < .001). A Gender × IPV interaction (p = .002) revealed that as IPV victimization increased, self-reported condom use at last sex decreased among girls, but increased among boys. A Gender × Relationship Power interaction (p = .004) indicated that as relationship power increased, self-reported condom use at last sex increased among girls, but decreased among boys. A Gender × IPV interaction (p = .004) indicated that as IPV victimization increased, self-reports of having multiple partners increased among boys, but not among girls. As relationship power increased, self-reports of having multiple partners decreased irrespective of gender. CONCLUSIONS HIV risk-reduction interventions and policies should address gender differences in sexual-risk consequences of IPV and relationship power among adolescents and promote gender equity. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | | | - G Anita Heeren
- University of Pennsylvania, Annenberg School for Communication
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Harrison A, Hoffman S, Mantell JE, Smit JA, Leu CS, Exner TM, Stein ZA. Gender-Focused HIV and Pregnancy Prevention for School-Going Adolescents: The Mpondombili Pilot Intervention in KwaZulu-Natal, South Africa. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2016; 15:29-47. [PMID: 27642267 PMCID: PMC5019561 DOI: 10.1080/15381501.2014.999183] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This pilot study evaluated a 15 session classroom intervention for HIV and pregnancy prevention among grade 8-10 boys and girls (ages 14-17) in rural South Africa, guided by gender-empowerment theory and implemented by teachers, nurses, and youth peer educators. Pre- and post-intervention surveys included 933 male and female students in two intervention and two comparison schools. MAIN OUTCOME condom use at last sex; secondary outcomes: partner communication; gender beliefs and values; perceived peer behaviors; self-efficacy for safer sex. At five months post-intervention, change in condom use did not differ between intervention and comparison schools. Intervention school youth had greater increases in self-efficacy for unsafe sex refusal [OR=1.61; 95% CI=1.01, 2.57] and condom use [OR=1.76; 95% CI=1.07, 2.89], partner communication [OR=2.42; 95% CI=1.27, 4.23], and knowledge of HIV testing opportunities [OR=1.76; 95% CI=1.08, 2.87]. This gender-focused pilot intervention increased adolescents' self-efficacy and partner communication, and has potential to improve preventive behaviors.
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Affiliation(s)
- Abigail Harrison
- Department of Behavioral and Social Sciences, School of Public Health, Brown University and Population Studies and Training Center, Providence, RI, USA
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Jennifer A Smit
- MatCH, University of the Witwatersrand, Durban, South Africa; School of Pharmacy and Pharmacology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA; Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Theresa M Exner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Zena A Stein
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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Chilisa B, Mohiemang I, Mpeta KN, Malinga T, Ntshwarang P, Koyabe BW, Heeren GA. Contextualized theory-based predictors of intention to practice monogamy among adolescents in Botswana junior secondary schools: Results of focus group sessions and a cross-sectional study. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2015; 26:533-540. [PMID: 28090169 PMCID: PMC5231395 DOI: 10.1080/10911359.2015.1114820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Culture and tradition influences behaviour. Multiple partner and concurrent relationships are made responsible for the increase of HIV infection in Sub-Saharan Africa. A contextualized "Theory of Planned Behaviour" was used to identify predictors of intention to practice monogamy. A mixed method design using qualitative data from focus groups, stories and a survey were analyzed for quantitative data. The qualitative data added to the behavioural beliefs a socio-cultural belief domain as well as attitudes, subjective norms, and perceived behavioural control predicted the intention to practice monogamy. The adolescents showed a tendency towards having more than one sexual partner. The normative beliefs and the socio cultural beliefs also predicted intentions while hedonistic belief and partner reaction did not. In contextualizing theory-based interventions, it is important to draw from stories and the langauage that circulate in a community about a given behaviour. More studies are needed on ways to combine qualitative approaches with quantitative approaches to inform the development of theory based culturally appropriate and context specific intervention strategies to reduce the risk of HIV.
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Affiliation(s)
- Bagele Chilisa
- Department of Educational Foundations, University of Botswana,
Gaborone, Botswana
| | - Irene Mohiemang
- Department of Educational Foundations, University of Botswana,
Gaborone, Botswana
| | | | - Tumane Malinga
- Department of Social Work, University of Botswana, Gaborone,
Botswana
| | - Poloko Ntshwarang
- Department of Social Work, University of Botswana, Gaborone,
Botswana
| | | | - G. Anita Heeren
- Department of Statistics, University of Fort Hare, Alice, South
Africa
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Huebner DM, Perry NS. Do behavioral scientists really understand HIV-related sexual risk behavior? A systematic review of longitudinal and experimental studies predicting sexual behavior. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1915-1936. [PMID: 26123067 DOI: 10.1007/s10508-015-0482-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/27/2014] [Accepted: 01/08/2015] [Indexed: 06/04/2023]
Abstract
Behavioral interventions to reduce sexual risk behavior depend on strong health behavior theory. By identifying the psychosocial variables that lead causally to sexual risk, theories provide interventionists with a guide for how to change behavior. However, empirical research is critical to determining whether a particular theory adequately explains sexual risk behavior. A large body of cross-sectional evidence, which has been reviewed elsewhere, supports the notion that certain theory-based constructs (e.g., self-efficacy) are correlates of sexual behavior. However, given the limitations of inferring causality from correlational research, it is essential that we review the evidence from more methodologically rigorous studies (i.e., longitudinal and experimental designs). This systematic review identified 44 longitudinal studies in which investigators attempted to predict sexual risk from psychosocial variables over time. We also found 134 experimental studies (i.e., randomized controlled trials of HIV interventions), but of these only 9 (6.7 %) report the results of mediation analyses that might provide evidence for the validity of health behavior theories in predicting sexual behavior. Results show little convergent support across both types of studies for most traditional, theoretical predictors of sexual behavior. This suggests that the field must expand the body of empirical work that utilizes the most rigorous study designs to test our theoretical assumptions. The inconsistent results of existing research would indicate that current theoretical models of sexual risk behavior are inadequate, and may require expansion or adaptation.
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Affiliation(s)
- David M Huebner
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84102, USA,
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O'Leary A, Jemmott JB, Jemmott LS, Bellamy S, Icard LD, Ngwane Z. Mediation of an efficacious HIV risk reduction intervention for South African men. AIDS Behav 2015; 19:1842-9. [PMID: 25969177 DOI: 10.1007/s10461-015-1042-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
"Men, Together Making a Difference!" is an HIV/STD risk-reduction intervention that significantly increased self-reported consistent condom use during vaginal intercourse compared with a health-promotion attention-control intervention among men (N = 1181) in Eastern Cape Province, South Africa. The present analyses were designed to identify mediators of the intervention's efficacy. The potential mediators were Social Cognitive Theory (SCT) constructs that the intervention targeted, including several aspects of condom-use self-efficacy, outcome expectancies, and knowledge. Mediation was assessed using a product-of-coefficients approach where an α path (the intervention's effect on the potential mediator) and a β path (the potential mediator's effect on the outcome of interest, adjusting for intervention) were estimated independently in a generalized estimating equations framework. Condom-use negotiation self-efficacy, technical-skill self-efficacy, and impulse-control self-efficacy were significant mediators. Although not mediators, descriptive norm and expected friends' approval of condom use predicted subsequent self-reported condom use, whereas the expected approval of sexual partner did not. The present results suggest that HIV/STD risk-reduction interventions that draw upon SCT and that address self-efficacy to negotiate condom use, to apply condoms correctly, and to exercise sufficient control when sexually aroused to use condoms may contribute to efforts to reduce sexual risk behavior among South African men. Future research must examine whether approaches that build normative support for condom use among men's friends are also efficacious.
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Affiliation(s)
- Ann O'Leary
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 8 Corporate Square Blvd., Atlanta, GA, 30329, USA.
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Zhang J, Jemmott JB, Jemmott LS. Mediation and moderation of an efficacious theory-based abstinence-only intervention for African American adolescents. Health Psychol 2015. [PMID: 26214076 DOI: 10.1037/hea0000244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This secondary data analysis sought to determine what mediated reductions in self-reported sexual initiation over the 24-month postintervention period in early adolescents who received "Promoting Health among Teens," a theory-based, abstinence-only intervention (Jemmott, Jemmott, & Fong, 2010). METHOD African American Grade 6 and 7 students at inner-city public middle schools were randomized to 1 of 5 interventions grounded in social-cognitive theory and the theory of reasoned action: 8-hr abstinence-only targeting reduced sexual intercourse; 8-hr safer-sex-only targeting increased condom use; 8-hr and 12-hr comprehensive interventions targeting sexual intercourse and condom use; 8-hr control intervention targeting physical activity and diet. Primary outcome was self-report of vaginal intercourse by 24 months postintervention. Potential mediators, assessed immediately postintervention, were theory-of-reasoned-action variables, including behavioral beliefs about positive consequences of abstinence and negative consequences of sex, intention to have sex, normative beliefs about sex, and HIV and sexually transmitted infection (STI) knowledge. We tested single and serial mediation models using the product-of-coefficients approach. RESULTS Of 509 students reporting never having vaginal intercourse at baseline (324 girls and 185 boys; mean age = 11.8 years, SD = 0.8), 500 or 98.2% were included in serial mediation analyses. Consistent with the theory of reasoned action, the abstinence-only intervention increased positive behavioral beliefs about abstinence, which reduced intention to have sex, which in turn reduced sexual initiation. Negative behavioral beliefs about sex, normative beliefs about sex, and HIV/STI knowledge were not mediators. CONCLUSIONS Abstinence-only interventions should stress the gains to be realized from abstinence rather than the deleterious consequences of sexual involvement.
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Crittenden KS, Kaponda CPN, Jere DL, McCreary LL, Norr KF. Participation and diffusion effects of a peer-intervention for HIV prevention among adults in rural Malawi. Soc Sci Med 2015; 133:136-44. [PMID: 25864150 DOI: 10.1016/j.socscimed.2015.03.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper examines whether a peer group intervention that reduced self-reported risky behaviors for rural adults in Malawi also had impacts on non-participants in the same communities. We randomly assigned two districts to the intervention and control conditions, and conducted surveys at baseline and 18 months post-intervention using unmatched independent random samples of intervention and control communities in 2003-2006. The six-session peer group intervention was offered to same-gender groups by trained volunteers. In this analysis, we divided the post-intervention sample into three exposure groups: 243 participants and 170 non-participants from the intervention district (total n = 415) and 413 control individuals. Controlling for demographics and participation, there were significant favorable diffusion effects on five partially overlapping behavioral outcomes: partner communication, ever used condoms, unprotected sex, recent HIV test, and a community HIV prevention index. Non-participants in the intervention district had more favorable outcomes on these behaviors than survey respondents in the control district. One behavioral outcome, community HIV prevention, showed both participation and diffusion effects. Participating in the intervention had a significant effect on six psychosocial outcomes: HIV knowledge (two measures), hope, condom attitudes, and self-efficacy for community HIV prevention and for safer sex; there were no diffusion effects. This pattern of results suggests that the behavioral changes promoted in the intervention spread to others in the same community, most likely through direct contact between participants and non-participants. These findings support the idea that diffusion of HIV-related behavior changes can occur for peer group interventions in communities, adding to the body of research supporting diffusion of innovations theory as a robust approach to accelerating change. If diffusion occurs, peer group intervention may be more cost-effective than previously realized. Wider implementation of peer group interventions can help meet the global goal of reducing new HIV infections.
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Affiliation(s)
| | - Chrissie P N Kaponda
- Kamuzu College of Nursing, University of Malawi, Private Bag 1, Lilongwe, Malawi
| | - Diana L Jere
- Kamuzu College of Nursing, University of Malawi, Private Bag 1, Lilongwe, Malawi
| | - Linda L McCreary
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, IL 60612, Chicago, USA
| | - Kathleen F Norr
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, IL 60612, Chicago, USA
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Myint KZY, Nonaka D, Jimba M, Nanishi K, Poudel KC, Yasuoka J, Miyagi M, Shinjo M, Kobayashi J. Unnecessary Dieting Intention and Behavior among Female Students in Naha City, Japan. Trop Med Health 2015; 43:131-40. [PMID: 26161031 PMCID: PMC4491491 DOI: 10.2149/tmh.2014-33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022] Open
Abstract
Weight concerns and dieting are prevalent among female adolescents both in Western and Asian countries. They can result in negative psychological and physiological consequences. This study aimed to examine the relative importance of social and personal factors in the decision to diet among female adolescent students in Japan, applying the Theory of Planned Behavior. Data were collected from five junior high schools and three high schools in Naha City, Okinawa Prefecture, in 2010, through self-administered questionnaires. The data of 756 female students were assessed. The independent variables included social factor variables (norms) and personal factor variables (attitude to dieting, perceived behavior control, body esteem, body-figure discrepancy and past dieting). The dependent variables were dieting intention and behavior. Hierarchical multiple regression analyses were performed to examine three models: model 1 (age and obesity index), model 2 (social factor variables with age and obesity index) and model 3 (all variables). Although model 2 failed to explain a substantial proportion of the variance, model 3 explained approximately a half of the variance for intention (R2 = 0.507) and more than one third of the variance for behavior (R2 = 0.376). Past experience of dieting was the best predictor of both dieting intention and behavior. Body esteem was the second best predictor for dieting behavior. In conclusion, personal factors are more likely than social factors to drive the dieting decision. Diet education programs should consider targeting frequent dieters and those with poor body esteem.
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Affiliation(s)
- Khin Zay Yar Myint
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo , Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Daisuke Nonaka
- Department of Global Health, School of Health Sciences, University of the Ryukyus , Uehara 207, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo , Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Keiko Nanishi
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo , Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Krishna Chandra Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst , 316 Arnold House, 715 North Pleasant St, Amherst, MA 01003-9304, USA
| | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo , Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Masaya Miyagi
- Faculty of Education, University of the Ryukyus , Senbaru 1, Nishihara-cho, Okinawa, 903-0213, Japan
| | - Masaki Shinjo
- Okinawa Prefectural College of Nursing , Yogi 1-24-1, Naha-shi, Okinawa, 902-8513, Japan
| | - Jun Kobayashi
- Department of Global Health, School of Health Sciences, University of the Ryukyus , Uehara 207, Nishihara-cho, Okinawa, 903-0215, Japan
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O'Leary A, Jemmott JB, Jemmott LS, Teitelman A, Heeren GA, Ngwane Z, Icard LD, Lewis DA. Associations between psychosocial factors and incidence of sexually transmitted disease among South African adolescents. Sex Transm Dis 2015; 42:135-9. [PMID: 25668645 PMCID: PMC4351752 DOI: 10.1097/olq.0000000000000247] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adolescents living in South Africa are at high risk for HIV and other sexually transmitted diseases (STDs). The present study sought to identify correlates of curable STD incidence among a cohort of adolescents in Eastern Cape Province, South Africa. METHODS Data were collected in conjunction with an HIV/STD prevention intervention randomized controlled trial. At 54 months postintervention, curable STD incidence (gonorrhea, chlamydial infection, and trichomoniasis) was assayed and self-report measures of potential correlates of STD incidence were collected. RESULTS Participants were adolescents reporting at least 1 sexual partner in the past 3 months (n = 659). As expected, univariate analyses revealed that girls were more likely than boys to have an STD. In addition, intimate partner violence, unprotected sex, and having older partners were associated with incident STD. In Poisson multiple regression analyses, sex (risk ratio [RR], 4.00; 95% confidence interval [CI], 2.51-6.39), intimate partner violence (RR, 1.23; 95% CI, 1.12-1.35), unprotected sex (RR, 1.42; 95% CI, 1.09-2.01), and multiple partners (RR, 1.70; 95% CI, 1.11-2.61), but not partner's age (RR, 1.00; 95% CI, 0.94-1.07) were associated with incident STD, adjusting for 42-month STD prevalence. Binge drinking, forced sex, and age were unrelated to STD incidence in both analyses. Interactions between sex and the hypothesized correlates were nonsignificant, suggesting that sex did not modify these relationships. CONCLUSIONS Interventions to reduce HIV/STD incidence among adolescents in South Africa should address the risk associated with sex, unprotected sex, intimate partner violence, and multiple partnerships.
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Affiliation(s)
- Ann O'Leary
- From the *Centers for Disease Control and Prevention, Atlanta GA; †University of Pennsylvania, Philadelphia, PA; ‡Haverford College, Haverford, PA; Temple University, Philadelphia, PA; and ¶Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, Johannesburg, South Africa; and ║Centre for Infectious Diseases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, Australia
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Factors contributing to the risk of HIV infection in rural school-going adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11805-21. [PMID: 25405598 PMCID: PMC4245644 DOI: 10.3390/ijerph111111805] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/20/2014] [Accepted: 11/10/2014] [Indexed: 11/16/2022]
Abstract
The objective of this study was to determine the factors that increase the risk of HIV infection in rural school-going adolescents and young adults. This was a cross-sectional study of 430 secondary school students (47.4% boys and 52.6% girls) from two rural schools in South Africa. Data were collected with a self-administered questionnaire on demographic information, sources of HIV/AIDS information, HIV knowledge, sexual behaviors, communication and negotiation skills, self-efficacy to refuse sex, peer influence and time perspective. Out of 113 (27.2%) participants who reported being sexually active, about 48% reported having had sex before the age of 15 and 42.2% reported penetrative sex with more than one partner in their lifetime. Only 44.8% of them reported consistent and regular use of condoms for every sexual encounter. Peer influence (OR = 3.01 (95% CI = 1.97-4.60)), gender difference (OR = 6.60 (95% CI = 1.62-26.84)) and lack of HIV information (OR = 1.22 (95% CI = 1.03-1.44)) influenced the sexual risk behaviors of the adolescents. Greater numbers of school-going adolescents in rural areas are sexually active. Peer influence, especially in boys, is a factor that increases the preponderance of risky sexual behaviors in adolescents. Positively, adolescents with high knowledge of HIV infection are more likely to use condoms for every sexual encounter. There is a need to strengthen comprehensive sexual health education and youth-friendly HIV prevention strategies to promote abstinence and safe sexual behaviors, especially among boys.
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Scott-Sheldon LAJ, Walstrom P, Harrison A, Kalichman SC, Carey MP. Sexual risk reduction interventions for HIV prevention among South African youth: a meta-analytic review. Curr HIV Res 2014; 11:549-58. [PMID: 24476351 DOI: 10.2174/1570162x12666140129105726] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 10/23/2013] [Accepted: 12/06/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To examine the efficacy of sexual risk reduction interventions among South African youth. METHODS Electronic databases were searched to identify studies published between 2007 and early 2013. Studies were eligible if they (1) targeted youth age 9-26, (2) evaluated sexual risk reduction interventions and (3) reported at least one behavioral outcome. Independent raters coded study characteristics, and intervention content. Weighted mean effect sizes were calculated; positive effect sizes indicated less sexual risk behavior and incident STIs. RESULTS Ten studies (k = 11; N = 22,788; 54% female; 79% Black-African) were included. Compared to controls, interventions were successful at delaying sexual intercourse and, among sexually active youth, at increasing condom use. A single study found reductions in the incidence of herpes simplex virus-2, but not HIV. CONCLUSIONS Implementing behavioral interventions to delay sexual debut and improve condom use can help to reduce the transmission of HIV among South African youth.
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Affiliation(s)
| | | | | | | | - Michael P Carey
- The Miriam Hospital, Centers for Behavioral and Preventive Medicine, CORO West, Suite 309, 164 Summit Ave., Providence, RI 02906, USA.
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Jemmott JB, Jemmott LS, O'Leary A, Ngwane Z, Lewis DA, Bellamy SL, Icard LD, Carty C, Heeren GA, Tyler JC, Makiwane MB, Teitelman A. HIV/STI risk-reduction intervention efficacy with South African adolescents over 54 months. Health Psychol 2014; 34:610-21. [PMID: 25110841 DOI: 10.1037/hea0000140] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Little research has tested HIV/sexually transmitted infection (STI) risk-reduction interventions' effects on early adolescents as they age into middle and late adolescence. This study tested whether intervention-induced reductions in unprotected intercourse during a 12-month period endured over a 54-month period and whether the intervention reduced the prevalence of STIs, which increase risk for HIV. METHOD Grade 6 learners (mean age = 12.4 years) participated in a 12-month trial in Eastern Cape Province, South Africa, in which 9 matched pairs of schools were randomly selected and within pairs randomized to a theory-based HIV/STI risk-reduction intervention or an attention-control intervention. They completed 42- and 54-month postintervention measures of unprotected intercourse (the primary outcome), other sexual behaviors, theoretical constructs, and, at 42- and 54-month follow-up only, biologically confirmed curable STIs (chlamydial infection, gonorrhea, and trichomoniasis) and herpes simplex virus 2. RESULTS The HIV/STI risk-reduction intervention reduced unprotected intercourse averaged over the entire follow-up period (OR = 0.42, 95% CI [0.22, 0.84]), an effect not significantly reduced at 42- and 54-month follow-up compared with 3-, 6-, and 12-month follow-ups. The intervention caused positive changes on theoretical constructs averaged over the 5 follow-ups, although most effects weakened at long-term follow-up. Although the intervention's main effect on STIs was nonsignificant, an Intervention Condition × Time interaction revealed that it significantly reduced curable STIs at 42-month follow-up in adolescents who reported sexual experience. CONCLUSION These results suggest that theory-based behavioral interventions with early adolescents can have long-lived effects in the context of a generalized severe HIV epidemic.
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Affiliation(s)
- John B Jemmott
- Annenberg School for Communication, University of Pennsylvania
| | | | | | | | | | - Scarlett L Bellamy
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania
| | - Larry D Icard
- College of Health Professions and Social Work, Temple University
| | - Craig Carty
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - G Anita Heeren
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
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Salam RA, Haroon S, Ahmed HH, Das JK, Bhutta ZA. Impact of community-based interventions on HIV knowledge, attitudes, and transmission. Infect Dis Poverty 2014; 3:26. [PMID: 25126420 PMCID: PMC4132935 DOI: 10.1186/2049-9957-3-26] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022] Open
Abstract
In 2012, an estimated 35.3 million people lived with HIV, while approximately two million new HIV infections were reported. Community-based interventions (CBIs) for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk, or already infected with, HIV. This paper evaluates the impact of CBIs on HIV knowledge, attitudes, and transmission. We included 39 studies on educational activities, counseling sessions, home visits, mentoring, women's groups, peer leadership, and street outreach activities in community settings that aimed to increase awareness on HIV/AIDS risk factors and ensure treatment adherence. Our review findings suggest that CBIs to increase HIV awareness and risk reduction are effective in improving knowledge, attitudes, and practice outcomes as evidenced by the increased knowledge scores for HIV/AIDS (SMD: 0.66, 95% CI: 0.25, 1.07), protected sexual encounters (RR: 1.19, 95% CI: 1.13, 1.25), condom use (SMD: 0.96, 95% CI: 0.03, 1.58), and decreased frequency of sexual intercourse (RR: 0.76, 95% CI: 0.61, 0.96). Analysis shows that CBIs did not have any significant impact on scores for self-efficacy and communication. We found very limited evidence on community-based management for HIV infected population and prevention of mother- to-child transmission (MTCT) for HIV-infected pregnant women. Qualitative synthesis suggests that establishment of community support at the onset of HIV prevention programs leads to community acceptance and engagement. School-based delivery of HIV prevention education and contraceptive distribution have also been advocated as potential strategies to target high-risk youth group. Future studies should focus on evaluating the effectiveness of community delivery platforms for prevention of MTCT, and various emerging models of care to improve morbidity and mortality outcomes.
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Affiliation(s)
- Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sarah Haroon
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Hashim H Ahmed
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan
- Center for Global Child Health Hospital for Sick Children, Toronto, Canada
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Assessing outcomes of a stigma-reduction intervention with venue-based analysis. Soc Psychiatry Psychiatr Epidemiol 2014; 49:991-9. [PMID: 24374721 PMCID: PMC4031272 DOI: 10.1007/s00127-013-0808-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE A randomized controlled trial with a matched design was conducted during October 2008 and February 2010, aiming at reducing HIV-related stigma in healthcare settings. METHODS Forty county hospitals in Fujian and Yunnan provinces of China were matched into pairs and randomized to either an intervention condition or a control condition. Forty-four service providers were randomly selected from each hospital, yielding a sample of 1,760. Intervention outcomes were assessed at baseline, 6 and 12 months based on venue-based pair comparisons. We identified and trained 30 popular opinion leaders in each intervention hospital among service providers to disseminate stigma-reduction messages to their peer providers. RESULTS Hospital and participant characteristics were comparable between the intervention and control conditions. Thirteen out of twenty pairs of hospitals showed significant reduction in the stigma outcome measure at the 6-month follow-up assessment. For most hospitals, the intervention effects were maintained at the 12-month follow-up assessment. Among the 13 pair of hospitals, which showed intervention effects at 6 months, eight were in Fujian and five were in Yunnan. The non-significant hospitals at 6 months had more beds than significant hospitals. However, the difference did not reach statistical significance. CONCLUSIONS A matched design and venue-based analysis provide more insight in assessing intervention effects for facility-based intervention trials. The identification of venue-based or hospital characteristics that are associated with intervention efficacy provides additional implications for the adaptation and implementation of future interventions.
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Caregivers' intentions to disclose HIV diagnosis to children living with HIV in South Africa: a theory-based approach. AIDS Behav 2014; 18:1027-36. [PMID: 24310931 DOI: 10.1007/s10461-013-0672-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
When children know their HIV serostatus, they are more likely to cooperate with steps to manage their health and the risk of transmitting HIV to others. Mounting evidence indicates that caregivers often do not disclose to HIV-positive children that the children are living with HIV, but little is known about the modifiable determinants of pediatric HIV disclosure. The present study examined theory-of-planned-behavior predictors of the intention to disclose to children their HIV diagnosis. The participants were 100 caregivers of HIV-positive children in Eastern Cape Province, South Africa. Proportional-odds logistic regression analysis revealed that normative support for disclosure and caregiver-child communication predicted the intention to disclose, whereas behavioral beliefs regarding the consequences of disclosing and self-efficacy to disclose did not. The results suggest that interventions to increase pediatric HIV disclosure in South Africa should help caregivers enlist support for disclosure among important referents and improve communication with their HIV-infected children.
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Icard LD, Jemmott JB, Teitelman A, O'Leary A, Heeren GA. Mediation effects of problem drinking and marijuana use on HIV sexual risk behaviors among childhood sexually abused South African heterosexual men. CHILD ABUSE & NEGLECT 2014; 38:234-42. [PMID: 24041455 PMCID: PMC4075286 DOI: 10.1016/j.chiabu.2013.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 07/31/2013] [Accepted: 08/03/2013] [Indexed: 05/25/2023]
Abstract
HIV/AIDS prevalence in South Africa is one of the highest in the world with heterosexual, transmission predominantly promoting the epidemic. The goal of this study is to examine whether, marijuana use and problem drinking mediate the relationship between histories of childhood sexual, abuse (CSA) and HIV risk behaviors among heterosexual men. Participants were 1181 Black men aged, 18-45 from randomly selected neighborhoods in Eastern Cape Province, South Africa. Audio computer assisted, self-interviewing was used to assess self-reported childhood sexual abuse, problem drinking, and marijuana (dagga) use, and HIV sexual transmission behavior with steady and casual partners. Data were analyzed using multiple meditational modeling. There was more support for problem, drinking than marijuana use as a mediator. Findings suggest that problem drinking and marijuana use, mediate HIV sexual risk behaviors in men with histories of CSA. Focusing on men with histories of CSA, and their use of marijuana and alcohol may be particularly useful for designing strategies to reduce, HIV sexual transmission in South Africa.
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Affiliation(s)
- Larry D Icard
- Center for Intervention and Practice Research, Temple University, College of Health Professions and Social Work, 1301 Cecil B. Moore Avenue, Ritter Annex, Suite B10, Philadelphia, PA 19121, USA
| | | | | | - Ann O'Leary
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Jemmott LS, Jemmott JB, Ngwane Z, Icard L, O’Leary A, Gueits L, Brawner B. 'Let Us Protect Our Future' a culturally congruent evidenced-based HIV/STD risk-reduction intervention for young South African adolescents. HEALTH EDUCATION RESEARCH 2014; 29:166-81. [PMID: 23962491 PMCID: PMC3894663 DOI: 10.1093/her/cyt072] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 06/10/2013] [Indexed: 05/31/2023]
Abstract
One of the worst HIV/AIDS epidemics in the world is occurring in South Africa, where heterosexual exposure is the main mode of HIV transmission. Young people 15-24 years of age, particularly women, account for a large share of new infections. Accordingly, there is an urgent need for behavior-change interventions to reduce the incidence of HIV among adolescents in South Africa. However, there are few such interventions with proven efficacy for South African adolescents, especially young adolescents. A recent cluster-randomized controlled trial of the 'Let Us Protect Our Future!' HIV/STD risk-reduction intervention for Grade 6 South African adolescents (mean age = 12.4 years) found significant decreases in self-reported sexual risk behaviors compared with a control intervention. This article describes the intervention, the use of the social cognitive theory and the reasoned action approach to develop the intervention, how formative research informed its development and the acceptability of the intervention. Challenges in designing and implementing HIV/STD risk-reduction interventions for young adolescents in sub-Saharan Africa are discussed.
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Affiliation(s)
- L. S. Jemmott
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - J. B. Jemmott
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Z. Ngwane
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - L. Icard
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - A. O’Leary
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - L. Gueits
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - B. Brawner
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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46
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Batidzirai JM, Heeren GA, Marange CS, Gwaze AR, Mandeya A, Ngwane Z, Jemmott JB, Tyler JC. Wake-Up. A Health Promotion Project for Sub-Saharan University Students: Results of Focus Group Sessions. MEDITERRANEAN JOURNAL OF SOCIAL SCIENCES 2014; 5:346-254. [PMID: 25763177 PMCID: PMC4352689 DOI: 10.5901/mjss.2014.v5n7p346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
HIV/AIDS is seen as the major killer in developing countries however, non-communicable diseases (NCDs), also referred to as chronic diseases, are the leading causes of death worldwide. University students are an important target for health promotion programmes because they are exposed to a new lifestyle where they have to determine on their own which diet to follow, whether or not to exercise, how much they drink alcohol or smoke, whether to have sex or abstain, as well as whether to practice safe sex or not Focus group sessions were held at a rural Sub-Saharan African University to assess students' knowledge on how to lead a healthy lifestyle. The results suggest a need for a health promotion intervention programme which should be culture-sensitive and considerate of the needs of university students.
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Affiliation(s)
- Jesca Mercy Batidzirai
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Private Bag X01, Scottsville, 3209, Pietermaritzburg , South Africa
| | - G Anita Heeren
- Department of Psychiatry, Department of Communication and Health Behavior, Perelman School of Medicine, University of Pennsylvania, Market Street 3535, Suite 520, Philadelphia PA 19104, USA
| | - C Show Marange
- Department of Biostatistics, University of Fort Hare, Private Bag X1314, Alice, South Africa
| | - Arnold Rumosa Gwaze
- Department of Biostatistics, University of Fort Hare, Private Bag X1314, Alice, South Africa
| | - Andrew Mandeya
- Department of Biostatistics, University of Fort Hare, Private Bag X1314, Alice, South Africa
| | - Zolani Ngwane
- Department of Anthropology, Haverford College, Lancaster Road, Haverford PA 19030, USA
| | - John B Jemmott
- Department of Psychiatry, Department of Communication and Health Behavior, Perelman School of Medicine, University of Pennsylvania, Market Street 3535, Suite 520, Philadelphia PA 19104, USA
| | - Joanne C Tyler
- Department of Biostatistics, University of Fort Hare, Private Bag X1314, Alice, South Africa
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Bogart LM, Skinner D, Thurston IB, Toefy Y, Klein DJ, Hu CH, Schuster MA. Let's Talk!, A South African worksite-based HIV prevention parenting program. J Adolesc Health 2013; 53:602-8. [PMID: 23566563 PMCID: PMC3707983 DOI: 10.1016/j.jadohealth.2013.01.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/07/2013] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE South African adolescents have high HIV risk, yet few prevention interventions are effective. Parents play a pivotal role in youths' healthy sexual development and may be at risk themselves. We tested whether Let's Talk!, a worksite-based parenting program, improves parent-child communication about HIV and sexual health and parent condom use self-efficacy and behavior. METHODS We culturally adapted Let's Talk! in two languages, drawing on formative research and community stakeholder input. We then conducted a small randomized test at a large public worksite in Cape Town, South Africa. The intervention consisted of 5 weekly 2-hour group sessions for parents of youth aged 11-15. Sixty-six parents (64% female) and their 64 adolescents (41% female) completed surveys before and 1-2 weeks post-intervention; surveys assessed comfort with talking about sex, communication about 16 HIV- and sex-related topics, and parents' condom use self-efficacy and behavior. Thirty-four black African (Xhosa language) and 32 coloured (mixed-race; Afrikaans language) parent-child dyads participated. Parents were randomized to intervention (n = 34) and control (n = 32) groups; randomization was stratified by language. RESULTS Multivariate regressions indicated that the intervention significantly increased parents' comfort with talking to their adolescent about sex, b(SE) = .98(.39), p = .02, and the number of sex- and HIV-related topics discussed with their adolescent, b(SE) = 3.26(1.12), p = .005. Compared with control parents, intervention parents were more likely to discuss new sex- and HIV-related topics not discussed before the intervention, b(SE) = 2.85(.80), p <.001. The intervention significantly increased parents' self-efficacy for condom use, b(SE) = .60(.21), p = .007. CONCLUSIONS Let's Talk! holds promise for improving parent-child communication, a critical first step in preventing HIV among youth.
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Affiliation(s)
- Laura M. Bogart
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital,Department of Pediatrics, Harvard Medical School
| | - Donald Skinner
- Research on Health and Society Unit, Stellenbosch University Faculty of Health Sciences
| | - Idia B. Thurston
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital,Department of Pediatrics, Harvard Medical School
| | - Yoesrie Toefy
- Research on Health and Society Unit, Stellenbosch University Faculty of Health Sciences
| | - David J. Klein
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital,Department of Pediatrics, Harvard Medical School
| | - Caroline H. Hu
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital
| | - Mark A. Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital,Department of Pediatrics, Harvard Medical School
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Brawner BM, Baker JL, Stewart J, Davis ZM, Cederbaum J, Jemmott LS. "The black man's country club": assessing the feasibility of an HIV risk-reduction program for young heterosexual African American men in barbershops. FAMILY & COMMUNITY HEALTH 2013; 36:109-18. [PMID: 23455681 PMCID: PMC3687538 DOI: 10.1097/fch.0b013e318282b2b5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Despite increasing HIV/AIDS morbidity and mortality, focus on young heterosexual African American men is limited. Nontraditional community-based prevention programs may be most effective for this demographic. Barbershops are one potential venue; however, barbers' and barbershop owners' views on the concept are less known. This paper describes attitudes and beliefs among barbers and barbershop owners regarding delivering a barber-facilitated, skills-based HIV risk-reduction intervention to their clientele. Participants believed that young heterosexual African American men were at significant risk for HIV and highly regarded the intervention model. This novel work contributes a voice to the literature that is infrequently heard.
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Affiliation(s)
- Bridgette M Brawner
- Center for Health Equity Research, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA.
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Heeren GA, Jemmott JB, Ngwane Z, Mandeya A, Tyler JC. A randomized controlled pilot study of an HIV risk-reduction intervention for sub-Saharan African university students. AIDS Behav 2013; 17:1105-15. [PMID: 22246515 DOI: 10.1007/s10461-011-0129-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This pilot study used a randomized controlled trial to test the efficacy of an HIV risk-reduction intervention for university students in Eastern Cape Province, South Africa. Randomly selected second-year students were randomized to one of two interventions based on social cognitive theory and qualitative research: HIV risk-reduction, targeting sexual-risk behaviors; health-promotion control, targeting health behaviors unrelated to sexual risks. Participants completed behavioral assessments via audio computer-assisted self-interviewing pre-intervention, 6, and 12 months post intervention, with 97.2% retained at 12-month follow-up. Averaged over the 2 follow-ups, HIV risk-reduction intervention participants reported less unprotected vaginal intercourse and more frequent condom use than control participants, with greater efficacy in non-South Africans than South Africans. Positive changes were also observed on theoretical mediators of condom use that the intervention targeted. Interventions based on social cognitive theory integrated with qualitative information from the population may reduce sexual risk behaviors among university students in sub-Saharan Africa.
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Affiliation(s)
- G Anita Heeren
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, PA 19104-3309, USA
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50
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O'Leary A, Jemmott JB, Jemmott LS, Bellamy S, Ngwane Z, Icard L, Gueits L. Moderation and mediation of an effective HIV risk-reduction intervention for South African adolescents. Ann Behav Med 2013; 44:181-91. [PMID: 22618963 DOI: 10.1007/s12160-012-9375-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND "Let Us Protect Our Future" is a sexual risk-reduction intervention for sixth-grade adolescents in South Africa. Tested in a cluster-randomized controlled trial, the intervention significantly reduced self-reported intercourse and unprotected intercourse during a 12-month follow-up period. PURPOSE The present analyses were conducted to identify moderators of the intervention's efficacy as well as, which theory-based variables mediated the intervention's effects. METHODS Intervention efficacy over the 3-, 6-, and 12-month follow-up was tested using generalized estimating equation models. RESULTS Living with their father in the home, parental strictness, and religiosity moderated the efficacy of the intervention in reducing unprotected intercourse. Self-efficacy to avoid risky situations and expected parental disapproval of their having intercourse, derived from Social Cognitive Theory, significantly mediated the intervention's effect on abstinence. CONCLUSIONS This is the first study to demonstrate that Social Cognitive variables mediate the efficacy of a sexual risk-reduction intervention among South African adolescents.
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Affiliation(s)
- Ann O'Leary
- Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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