The Long-Term Impact of the MEMA kwa Vijana Adolescent Sexual and Reproductive Health Intervention: Effect of Dose and Time since Intervention Exposure

Sheena McCormack,John Changalucha,Richard J. Hayes,Saidi Kapiga,Sten H. Vermund,Aoife M. Doyle,Helen A. Weiss,Kaballa Maganja,Deborah Watson-Jones,David A. Ross

doi:10.1371/journal.pone.0024866

Abstract

BackgroundDespite recent decreases in HIV incidence in many sub-Saharan African countries, there is little evidence that specific behavioural interventions have led to a reduction in HIV among young people. Further and wider-scale decreases in HIV require better understanding of when behaviour change occurs and why. The MEMA kwa Vijana adolescent sexual and reproductive health intervention has been implemented in rural Mwanza, Tanzania since 1999. A long-term evaluation in 2007/8 found that the intervention improved knowledge, attitudes to sex and some reported risk behaviours, but not HIV or HSV2 prevalence. The aim of this paper was to assess the differential impact of the intervention according to gender, age, marital status, number of years of exposure and time since last exposure to the intervention.MethodsIn 2007, a cross-sectional survey was conducted in the 20 trial communities among 13,814 young people (15–30 yrs) who had attended intervention or comparison schools between 1999 and 2002. Outcomes for which the intervention had an impact in 2001 or 2007 were included in this subgroup analysis. Data were analysed using cluster-level methods for stratified cluster-randomised trials, using interaction tests to determine if intervention impact differed by subgroup.ResultsTaking into account multiplicity of testing, concurrence with a priori hypotheses and consistency within the results no strong effect-modifiers emerged. Impact on pregnancy knowledge and reported attitudes to sex increased with years of exposure to high-quality intervention.ConclusionsThe desirable long-term impact of the MEMA kwa Vijana intervention did not vary greatly according to the subgroups examined. This suggests that the intervention can have an impact on a broad cross-section of young people in rural Mwanza.Trial registrationClinicalTrials.gov NCT00248469

Highlights

Young people are at the centre of the HIV pandemic in terms of new infections and opportunities for halting the transmission of HIV[1,2,3]
There is no direct evidence that specific behaviour change interventions among young people reduce HIV incidence[6,7]
The household census and follow-up visits to nearby secondary schools and major migration points identified 16,747 young people who were potentially eligible to participate in the MEMA kwa Vijana (MkV) long-term impact evaluation survey. 13,281 (79%) of invited individuals attended on the survey day along with 2,426 non-invited young people

Summary

Introduction

Young people are at the centre of the HIV pandemic in terms of new infections and opportunities for halting the transmission of HIV[1,2,3]. Surveillance data suggests that the UNGASS target of reducing HIV prevalence among young people aged 15–24 yrs living in the most affected countries by 25% by 2010[4] will be met by at least half of the countries where adequate data on trends are available[5]. In many of these countries, declines in HIV prevalence have been accompanied by changes in reported sexual behaviour measured in behavioural surveillance surveys. The aim of this paper was to assess the differential impact of the intervention according to gender, age, marital status, number of years of exposure and time since last exposure to the intervention

Objectives

Methods

Results

Conclusion