Preliminary effectiveness and implementation outcomes of the Imara-South Africa sexual health intervention on adolescent girls and young women

A pilot randomized trial

Bibliographic Data

ID19591713
AuthorsKatherine G Merrill (0000-0001-5308-4154, University of Illinois Chicago, corresponding author), Millicent Atujuna (0000-0003-1287-2634, Desmond Tutu HIV Foundation), Erin Emerson (University of Illinois Chicago), Dara Blachman-Demner (0000-0002-7837-0525, National Institutes of Health), Bethany C Bray (0000-0001-8627-3939, University of Illinois Urbana-Champaign), Linda-Gail Bekker (0000-0002-0755-4386, Desmond Tutu HIV Foundation), Geri R Donenberg (0000-0002-7925-0488, University of Illinois Chicago)
EditorsJohn M Francis (0000-0003-1902-2683)
Year2023
Volume3
Issue2
Pagese0001092
Publication date2023-02-15
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0001092
PMID36962830
OpenAlexW4320907705
LanguageEN
Citations received6
References cited31

Family-based interventions may help reduce the risk of HIV and other sexually transmitted infections (STI) among adolescent girls and young women (AGYW) in sub-Saharan Africa but few have been tested. We examined the preliminary effectiveness and implementation outcomes of I nformed , M otivated , A ware , and R esponsible A dolescents and Adults— S outh A frica (IMARA-SA) , an evidence-based intervention for South African AGYW (15–19 years) and their female caregivers. We piloted IMARA-SA in the Western Cape using an individually randomized experimental design and average follow-up at 11 months. Primary outcomes were HIV Testing and Counselling (HTC) uptake, STI incidence (gonorrhea, chlamydia), and pre-exposure prophylaxis (PrEP) uptake. Secondary outcomes were self-reported sexual risk behavior (condom use at last sex, consistency of condom use, substance use during sex, and number of sexual partners) and PrEP adherence. We examined four implementation outcomes: reach, feasibility, acceptability, and fidelity. Data from 59 AGYW (mean = 17.2 years) were analyzed at baseline (n = 29 from IMARA-SA, 30 from a health promotion control group). At follow-up, 51 (86%) completed surveys and 39 (66%) presented for HTC, STI testing, and/or PrEP. Compared to controls, fewer IMARA-SA participants tested positive for an STI (22% versus 38%), more IMARA-SA participants took up PrEP (68% versus 45%), and four of five secondary outcomes favored the IMARA-SA group at follow-up. These differences did not reach statistical significance. HTC uptake at follow-up was 100% in both groups. All AGYW-FC dyads agreed to participate in the study (reach). In the IMARA-SA group, 76% of dyads completed the intervention (feasibility), and over 76% of acceptability ratings from AGYW and their FC had the highest Likert rating. Fidelity of intervention delivery was 95%. IMARA-SA is a promising strategy for reducing HIV/STI risk among South African AGYW. We found strong evidence of reach, feasibility, acceptability, and fidelity. A fully powered randomized controlled trial is warranted. Trial registration: Clinical trials.gov registration number: NCT05504954

Chlamydia · Condom · Environmental health · Family medicine · Gonorrhea · Men who have sex with men · Population · Pre-exposure prophylaxis · Psychiatry · Psychological intervention · Randomized controlled trial · Reproductive health · Syphilis · Adolescent Sexual and Reproductive Health · Demography · Food Security and Health in Diverse Populations · HIV/AIDS Research and Interventions · Medicine · Internal Medicine