Impact evaluation of scripted lesson plans for HIV-related content in a life orientation curriculum: results from two provinces in South Africa

Abstract

Background Young people under age 25 years are a key population at risk of unintended pregnancies, HIV and other sexually transmitted infections. School-based programming, focusing on youth under 17 years is strategic given that many in this age group are in school or are required to be in school and spend a considerable amount of their time at school. Prior evaluations of school-based HIV prevention programs for young people often employed weak study designs or lacked biomarkers (e.g., HIV or STI testing) to inform outcomes. Methods This study used longitudinal data collected in 2016 from a cohort of grade-8 girls from Mpumalanga and KwaZulu-Natal Provinces in South Africa. We followed them for 2 years to examine the impact of the South African Department of Basic Education’s revised scripted lesson plans for the HIV and sexual content of a “life orientation” curriculum on knowledge, attitudes, condom use behaviors, pregnancy incidence, and genital herpes incidence. Schools were randomized to intervention and control arms. Multivariable analyses were undertaken using hazard modeling for incidence-based outcomes (genital herpes and pregnancy) and generalized linear latent and mixed modeling for outcomes measured at each time period (knowledge, attitudes, and condom use). Results At end line, 105 schools were included from the two provinces (44 from Mpumalanga and 61 from KwaZulu-Natal). Fifty-five were intervention and fifty were control schools. A total of 2802 girls were surveyed at both time periods (1477 intervention and 1325 control). At baseline, participating girls were about 13.6 years; by end line, they were about 2 years older. Longitudinal data demonstrated few differences between intervention and control groups on knowledge, attitudes, condom use, genital herpes, and pregnancy experience. Monitoring data demonstrated that the program was not implemented as intended. Our results demonstrated 7% incidence of genital herpes in the two-year follow-up period indicating sexual risk-taking among our cohort. Conclusions We did not find significant effects of the revised life orientation curriculum on key outcomes; however, this may reflect poor implementation. Future HIV prevention programs for young people need to be implemented with fidelity to ensure they meet the crucial needs of the next generation. Trial Registration: This study has been registered at ClinicalTrials.gov. The trial registration number is: NCT04205721. The trial was retrospectively registered on December 18, 2019.

Demand creation for HIV testing services: A systematic review and meta-analysis

“…Fourteen RCTs examined the role of general HIV counseling messages and content prior to HTS [ 70 – 83 ] ( Table 1 ). Eight studies were conducted in the Americas [ 70 – 72 , 75 , 76 , 81 – 83 ], 3 in Africa [ 73 , 77 , 79 ], 2 in Southeast Asia [ 74 , 80 ], and 1 in Europe [ 78 ]. One study focused on general population adults [ 74 ], 4 on women [ 75 , 77 , 78 , 80 ], 1 on MSM [ 83 ], 3 on PWID [ 70 , 72 , 75 ], and 5 on adolescents [ 71 , 73 , 76 , 79 , 81 ], one of which focused on transgender and non-binary adolescents [ 81 ].…”

“…Among the 14 RCTs reported on HTS uptake following general HIV counseling messages [ 70 – 83 ], a meta-analysis of 7 RCTs [ 70 – 72 , 78 , 79 , 83 , 95 ] showed HIV-specific information and counseling messages prior to testing significantly but not importantly increased HTS uptake compared to standard services (RR: 1.22, 95% CI [1.01, 1.48], p < 0.05; I 2 = 64.6%; RD: 0.05, 95% CI [0.00, 0.10], p < 0.05; I 2 = 76.5%) (Figs 3 and 4 and S7 Appendix ) with medium risk of bias. Two RCTs [ 77 , 80 ] reported on HTS uptake following HIV-specific counseling and economic empowerment.…”

Role of Schooling and Comprehensive Sexuality Education in Reducing HIV and Pregnancy Among Adolescents in South Africa

“…The quality of CSE lessons is likely to be differential across schools, districts, and provinces, with other studies unearthing implementation challenges. 26 The fidelity of CSE implementation is likely to play an important role in preventing risky behaviour and linking adolescent girls to appropriate services should be measured in future studies.…”

Contraception knowledge and uptake among in-school adolescents in three South African townships: Baseline findings from the Girls Achieve Power (GAP Year) Trial

“…This is to ensure they are kept abreast of what their children are learning 27 . In South Africa, the Department of Education introduced scripted lesson plans in 2010 to strengthen the SRH content and standardize implementation of the Life Orientation Curriculum 50 . Despite the technical support school teachers received, including training on the delivery and content, no impact was observed on the primary outcomes of HIV knowledge, attitudes, condom use, pregnancy incidence, and genital herpes incidence 50 .…”

“…In South Africa, the Department of Education introduced scripted lesson plans in 2010 to strengthen the SRH content and standardize implementation of the Life Orientation Curriculum 50 . Despite the technical support school teachers received, including training on the delivery and content, no impact was observed on the primary outcomes of HIV knowledge, attitudes, condom use, pregnancy incidence, and genital herpes incidence 50 . These findings raise the issue of whether this was due to the programme being ineffectively designed or challenges with programme implementation and lack of programme fidelity 51,52 .…”