The Young Women’s Health CoOp in Cape Town, South Africa: Study protocol for a cluster-randomised trial for adolescent women at risk for HIV

Abstract

BackgroundSouth Africa remains the global epicentre of HIV infection, and adolescent women have the highest incidence of HIV in the country. South Africa also has high rates of alcohol and other drug (AOD) use, violence, and gender inequality. Violence converges with AOD use, gender inequities and other disparities, such as poverty, to increase sexual risk and poor educational attainment for adolescent women. This study seeks to test the efficacy of peer recruitment and cofacilitation of the Young Women’s Health CoOp (YWHC), a comprehensive gender-focused intervention to reduce HIV risk behaviours and increase the uptake of HIV counselling and testing (HCT) among out-of-school, adolescent women who use AODs. The YWHC is facilitated by local research staff and supported by peers.MethodsThis cluster-randomised trial is enrolling participants into two arms: a control arm that receives standard HCT, and an intervention arm that receives the YWHC. Participants are enrolled from 24 economically disadvantaged communities in Cape Town, South Africa. These geographically distinct communities serve as clusters that are the units of randomisation. This study uses adolescent peer role models and research field staff to recruit marginalised adolescent women. At baseline, participants complete a questionnaire and biological testing for HIV, recent AOD use, and pregnancy. The core intervention is delivered in the month following enrollment, with linkages to health services and educational programmes available to participants throughout the follow-up period. Follow-up interviews and biological testing are conducted at 6 and 12 months post enrollment.DiscussionThe study findings will increase knowledge of the efficacy of a comprehensive HCT, gender-focused programme in reducing AOD use, victimisation, and sexual risk behaviour and increase uptake services for out-of-school, adolescent women who use AODs. The trial results could lead to wider implementation of the YWHC for vulnerable adolescent women, a key population often neglected in health services.Trial registrationTrial registration no: NCT02974998, November 29, 2016.

Youth engagement in HIV prevention intervention research in sub‐Saharan Africa: a scoping review

“…Following our secondary search for studies that described the interventions identified, we found 27 additional manuscripts. Thus, the total number of manuscripts reviewed was 112 [19‐130]. These manuscripts described 74 unique intervention research studies (Table 1) […”

“…Both studies were conducted after 2010. We also assessed of the extent of youth engagement over time by comparing engagement in studies conducted in or before 2010 [19,20,22,23,25‐27,31,33,34,39‐41,45‐48,52‐54,59,60,66,68,72,73,77,78,80,82,83,88,89,109,115,121,130], to studies conducted after 2010 [21,24,28‐30,32,35‐37,42‐44,50,51,56‐58,60,62‐64,67,69‐71,75,76,79,81,84‐86,90,100,110,111,129]. We found youth engagement in 28 out of 37 interventions (76%) conducted in or before 2010, and in 30 out of 37 interventions (81%) conducted after 2010.…”

Women’s Empowerment and Women’s Health in Africa

“…Several studies have highlighted the health status of women in Africa, with emphasis on the major health challenges that they face such difficulties with access to maternal and reproductive health care services (Boerma et al 2008;Tapera 2018;Weschsberg et al 2018;Victora et al 2016;Fawole 2015; WHO 2015). They did not make any direct link between women's health and women empowerment in the African context.…”

The PrEPARE Pretoria Project: protocol for a cluster-randomized factorial-design trial to prevent HIV with PrEP among adolescent girls and young women in Tshwane, South Africa

“…Parental waiver has been requested to protect a participant’s confidentiality if they are uncomfortable having their mother consent for them. This approach has been used successfully in our previous South African studies with adolescents [ 19 , 51 ]. In loco parentis enables the participant to select a female adult (either identified by the participant themselves or by the study staff) to provide consent on her behalf.…”

“…Recruitment is conducted via street outreach at identified areas where AGYW are known to frequent. Street outreach is an established recruitment method that has been used successfully in previous research studies [50][51][52][53], including Tshwane WHC studies to reach and recruit a high number of women most at risk of HIV. Study staff visit these hotspots regularly to establish a known presence in the community and gain rapport with community members.…”