A quasi-experimental evaluation of an HIV prevention programme by peer education in the Anglican Church of the Western Cape, South Africa

Abstract

IntroductionReligion is important in most African communities, but faith-based HIV prevention programmes are infrequent and very rarely evaluated.ObjectiveThe aim of this study was to evaluate the effectiveness of a church-based peer education HIV prevention programme that focused on youth.DesignA quasi-experimental study design compared non-randomly chosen intervention and control groups.SettingThis study was conducted in the Cape Town Diocese of the Anglican Church of Southern Africa.ParticipantsThe intervention group of 176 teenagers was selected from youth groups at 14 churches and the control group of 92 from youth groups at 17 churches. Intervention and control churches were chosen to be as similar as possible to decrease confounding.InterventionThe intervention was a 20-session peer education programme (Fikelela: Agents of Change) aimed at changing risky sexual behaviour among youth (aged 12–19 years). Three workshops were also held with parents.Primary and secondary outcome measuresThe main outcome measures were changes in age of sexual debut, secondary abstinence, condom use and numbers of partners.ResultsThe programme was successful at increasing condom usage (condom use score 3.5 vs 2.1; p=0.02), OR 6.7 (95% CI 1.1 to 40.7), and postponing sexual debut (11.9% vs 21.4%; p=0.04) absolute difference 9.5%. There was no difference in secondary abstinence (14.6% vs 12.5%; p=0.25) or with the number of partners (mean 1.7 vs 1.4; p=0.67) and OR 2.2 (95% CI 0.7 to 7.4).ConclusionAn initial exploratory quasi-experimental evaluation of the Agents of Change peer education programme in a church-based context found that the age of sexual debut and condom usage was significantly increased. The study demonstrated the potential of faith-based peer education among youth to make a contribution to HIV prevention in Africa. Further evaluation of the effectiveness of the programme is, however, required before widespread implementation can be recommended.

Measuring change in vulnerable adolescents: Findings from a peer education evaluation in South Africa

“…Thus, it may be argued that Vhutshilo increased young people's sense of agency. These findings are in keeping with those recorded with regard to MCPs (Mash & Mash 2012), changes in HIV attitudes and knowledge (Ott et al 2003), and young people's proclivity to engage more actively in discussion after peer-led sessions (Rickert et al 1991).…”

“…Third, the unavailability of existing survey questions to measure the impact of peer education and its role in behaviour change, and the lack of resources required to design new questions, was a final limitation. Mash and Mash (2012) have also noted the need for more effective peer education evaluations. However, research will always be constrained by available resources.…”

“…Studies using more rigorous designs have found that peer education programmes lead to increased levels of knowledge, testing and help-seeking with regard to sexually transmitted infections, reports of condom use to prevent HIV infection, delayed sexual debut, and fewer reports of MCPs (Mash & Mash 2012;Sawyer et al 1997;Visser 2007). Other research has found variously that programmes with peer educators are as effective as those taught by adults in changing adolescent knowledge about HIV, beliefs and risk behaviour (Ott, Evens, Halpern-Felsher & Eyre 2003;Sciacca & Black 1996), that adolescents are more likely to engage in interactive discussions after peer-led sessions than they are after sessions led by adults (Rickert, Jay & Gottlieb 1991) and that peer educators themselves receive enhanced health outcomes (Strange, Forrest, Oakley & The Ripple Study Team 2002).…”

“…Programmes that target sexual and reproductive health, specifically with regard to HIV prevention among adolescents, concentrate on harm-reduction information, prevention, early intervention and support (Campbell & Foulis 2002;Delp, Brown & Domenzain 2005;Story, Lytle, Birnbaum & Perry 2002;Wiist & Snider 1991). Studies in South Africa increasingly have evaluated peer education as a mechanism to promote behaviour and attitude change (Campbell & MacPhail 2002;Cornish & Campbell 2009;Dickinson 2009;Mash & Mash 2012;Mukoma, Flisher, Ahmed, Jansen, Mathews, Klepp, et al 2009;Sloane & Zimmer 1993;Thupayagale-Tshweneagae 2011;Visser 2007).…”

HIV/AIDS Knowledge, Self-Efficacy for Limiting Sexual Risk Behavior and Parental Monitoring

“…HIV peer education has been found to be effective in improving adolescent's HIV/AIDS knowledge, intentions regarding condom use, self-efficacy to refuse sex, and delay in sexual behaviors (Caron et al, 2004;Mash & Mash, 2014). One study reported contradictory findings concluding that a peer education program was not effective in reducing the age of sexual debut or condom use (Mason-Jones, Mathews, & Flisher, 2011).…”