One important purpose of this project is to develop research-based, culture- and gender-sensitive, sustainable, community-based interventions to promote sexual and reproductive health among adolescents aged 12 to 14 years in southern and eastern Africa. The aim of the interventions for these studies is that the adolescents use condoms correctly and consistently, postpone sexual debut, or reduce the number of sexual partners. Two comprehensive interventions are developed and implemented in Dar es Salaam and Cape Town. In two sites, Kampala and Mankweng, the interventions will be more focussed.
All interventions will be community-based and use schools as their gateway to delivery. In addition to this, each site will pay attention to one particular theme.
The themes are
In each site the interventions are evaluated with cluster randomized controlled trials (RCTs) with schools as the unit of allocation.
Sub-Saharan Africa has higher incidence and prevalence of HIV infections than any other region or sub-region in the world. Heterosexual transmission is widespread. It is urgent to develop efficacious and effective interventions targeting adolescents.
The main aim of the PREPARE project is to develop new and innovative community-based programmes for the promotion of healthy sexual practices among adolescents in their early adolescence using schools as a gateway to delivery.
The project has six specific objectives:
PREPARE investigators have conducted and published systematic reviews on interventions for adolescent sexual and reproductive health (two reviews) and on adolescent HIV prevention trial outcomes (one review). A systematic review on intimate partner violence prevention among adolescents, published in the Journal of Adolescent Health, found that effective interventions are more likely to be based in multiple settings, and focus on key people in the adolescent’s environment.
A systematic review on the effects of school health services on adolescent sexual, reproductive and mental health, published in Systematic Reviews, found that these services appear to have cost benefits in terms of adolescent health and society as a whole by reducing health disparities and attendance at secondary care facilities. However there is a paucity of high quality research evaluating school health services. A review of herpes simplex virus type 2 infection as a biomarker for sexual debut among young people in sub-Saharan Africa, published in the International Journal of STD & AIDS, showed that it was an inadequate marker due to its low transmission probabilities and that HSV-2 prevalence is not 100% among potential sexual partners. This led us to recommend that the identification of alternative biological measures is prioritized.
After the data collections have been completed, papers describing effects of the interventions will be published. Furthermore, the project will throw light on factors and processes influencing health related behaviours and contribute to strengthening the knowledge base for further development of health behaviour interventions in sub-Saharan Africa.
Important applications will be within the field of developing effective interventions for promoting healthy sexual practices among adolescents in sub-Saharan Africa.