Accelerating Sustainable Development Goals for South African adolescents from high HIV prevalence areas: a longitudinal path analysis

Abstract

Background Adolescents experience a multitude of vulnerabilities which need to be addressed in order to achieve the Sustainable Development Goals (SDGs). In sub-Saharan Africa, adolescents experience high burden of HIV, violence exposure, poverty, and poor mental and physical health. This study aimed to identify interventions and circumstances associated with three or more targets (“accelerators”) within multiple SDGs relating to HIV-affected adolescents and examine cumulative effects on outcomes. Methods Prospective longitudinal data from 3401 adolescents from randomly selected census enumeration areas in two provinces with > 30% HIV prevalence carried out in 2010/11 and 2011/12 were used to examine six hypothesized accelerators (positive parenting, parental monitoring, free schooling, teacher support, food sufficiency and HIV-negative/asymptomatic caregiver) targeting twelve outcomes across four SDGs, using a multivariate (multiple outcome) path model with correlated outcomes controlling for outcome at baseline and socio-demographics. The study corrected for multiple-hypothesis testing and tested measurement invariance across sex. Percentage predicted probabilities of occurrence of the outcome in the presence of the significant accelerators were also calculated. Results Sample mean age was 13.7 years at baseline, 56.6% were female. Positive parenting, parental monitoring, food sufficiency and AIDS-free caregiver were variously associated with reductions on ten outcomes. The model was gender invariant. AIDS-free caregiver was associated with the largest reductions. Combinations of accelerators resulted in a percentage reduction of risk of up to 40%. Conclusion Positive parenting, parental monitoring, food sufficiency and AIDS-free caregivers by themselves and in combination improve adolescent outcomes across ten SDG targets. These could translate to the corresponding real-world interventions parenting programmes, cash transfers and universal access to antiretroviral treatment, which when provided together, may help governments in sub-Saharan Africa more economically to reach their SDG targets.

Understanding accelerators to improve SDG-related outcomes for adolescents—An investigation into the nature and quantum of additive effects of protective factors to guide policy making

“…Our data clearly show that different outcomes may require different combinations of protective factors, which is in accordance with what has been found in previous accelerator studies [e.g., 8,11,17,28]. The pattern emerging from the current data seems to suggest that two to three protective factors can often provide a substantial boost, while additional factors provide for marginal gain and diminishing returns.…”

“…Importantly, the UNDP SDG Accelerator and Bottleneck assessment distinguishes between accelerators, defined as life circumstances/ protective factors that directly influence SDG outcomes (e.g., food security or good parenting), and interventions, which can drive progress on access to these accelerators (e.g., feeding or parenting programmes) [10]. Evidence using observational data has identified a range of protective factors and their combinations (accelerator synergies) that bolster multiple outcomes for children and adolescents and can thus contribute to the accelerator model: safe schools [8], good parenting/parenting support [8,11], cash transfers [12], food security [11][12][13], living in a safe community [12,13], good mental health [14], education, ICT access [15], no survival work, small family size, food security, health extension [16], healthy caregivers [17] and access to community-based organisations [13]. There are now also programs emerging that are based on the idea of layered evidence-based services, such as the DREAMS programme, which aims to address the complex problem of high HIV incidences through a combined portfolio of provisions [18].…”

Accelerating progress towards improved mental health and healthy behaviours in adolescents living in adversity: findings from a longitudinal study in South Africa

“…The accelerator approach has since been successfully applied in several studies (Cluver et al, 2020;Mebrahtu et al, 2021;Meinck et al, 2021). Of note, several of these studies have found positive effects of different accelerators on several indicators of mental health (Mebrahtu et al, 2021;Meinck et al, 2021). Building on such findings, the current study applies the accelerator approach to identify measures that may improve several, inter-related mental health outcomes simultaneously.…”

“…They found that three provisions (parenting support, government cash transfers, and safe schools) were associated with better outcomes across 11 SDG-aligned targets (Cluver et al, 2019). The accelerator approach has since been successfully applied in several studies (Cluver et al, 2020;Mebrahtu et al, 2021;Meinck et al, 2021). Of note, several of these studies have found positive effects of different accelerators on several indicators of mental health (Mebrahtu et al, 2021;Meinck et al, 2021).…”

Accelerating ontological security for South African adolescents living in high HIV-prevalence areas: a longitudinal study

“…To our knowledge, the current study makes the first attempt to measure two unexplored dimensions of ontological security (violence and mental health), aligning them with SDG targets. Second, most studies focusing on accelerators used cross-sectional data and longitudinal data up to two time points (Chipanta et al, 2022;Cluver et al, 2019;Haag et al, 2022;Mebrahtu et al, 2021;Meinck et al, 2021). The current study is one of the first accelerator research using data from three time points, which could pose essential understanding of the long-term effects of consistent exposure to accelerators, enhancing their potential to be considered protective factors (Rudgard et al, 2022).…”