Effects of PREPARE, a Multi-component, School-Based HIV and Intimate Partner Violence (IPV) Prevention Programme on Adolescent Sexual Risk Behaviour and IPV: Cluster Randomised Controlled Trial

Abstract

Young South Africans, especially women, are at high risk of HIV. We evaluated the effects of PREPARE, a multi-component, school-based HIV prevention intervention to delay sexual debut, increase condom use and decrease intimate partner violence (IPV) among young adolescents. We conducted a cluster RCT among Grade eights in 42 high schools. The intervention comprised education sessions, a school health service and a school sexual violence prevention programme. Participants completed questionnaires at baseline, 6 and 12 months. Regression was undertaken to provide ORs or coefficients adjusted for clustering. Of 6244 sampled adolescents, 55.3 % participated. At 12 months there were no differences between intervention and control arms in sexual risk behaviours. Participants in the intervention arm were less likely to report IPV victimisation (35.1 vs. 40.9 %; OR 0.77, 95 % CI 0.61–0.99; t(40) = 2.14) suggesting the intervention shaped intimate partnerships into safer ones, potentially lowering the risk for HIV.

Effects of Interventions Addressing School Environments or Educational Assets on Adolescent Sexual Health: Systematic Review and Meta‐analysis

“…Of the five school‐level environment interventions, three employed teams of school staff and students to improve school policies or practices addressing school climate or to improve safety and prevent sexual violence . Two interventions provided teachers with knowledge and skills related to classroom management and interactive teaching or to strategies to support actions recommended by school teams .…”

“…Only one meta‐analysis was possible for outcomes of school‐environment studies. Three randomized trials reported intervention effects on sexual debut and were included in the meta‐analysis. The first trial, the Gatehouse Project, involved 25 secondary schools in Australia and reported on sexual debut (i.e., whether students had ever had sexual intercourse) among three cross‐sectional samples of eighth‐grade students at two and four years after baseline .…”

“…Positive Action, the second trial, assessed sexual debut (i.e., lifetime voluntary sexual activity with the opposite gender) at four years postbaseline among a sample of U.S. youth from 20 schools who had been fifth graders at baseline . The third trial, PREPARE, was the only school‐level environment intervention evaluated in a low‐ or middle‐income country (South Africa) . Sexual debut outcomes (i.e., whether youth had ever had vaginal or anal sex) were reported at six and 12 months after baseline among students (average age, 14 years at baseline) from 42 schools.…”

“…Two sexual debut outcomes were not included in the meta‐analysis. In addition to assessing initiation of vaginal or anal intercourse (the measure considered above), PREPARE examined a broader definition of sexual debut that included oral sex as well as vaginal and anal sex, and found no benefits from the intervention at either time point . The sexual debut outcome (i.e., lifetime sexual activity) from the Seattle Social Development Project (SSDP) was not included in the pooled analysis because the U.S. study used a quasi‐experimental design.…”

Study protocol for a cluster randomised controlled trial to assess the effectiveness of user-driven intervention to prevent aggressive events in psychiatric services

“…The recent large-scale trials covering wide geographical areas in the United Kingdom [46–49], South Africa [50] and Switzerland [51] have encouraged us to design and conduct a nation-wide cluster randomised clinical trial to test the effects of user-centred and collaborative intervention to prevent and decrease coercive events in psychiatric hospitals. Contrary experiences of the impact of large-scale intervention trials also exist.…”