South African District Research Articles

Exploring causes of bullying among grade eight and nine learners in a South African education district

Bullying is a social phenomenon that has become a complex problem worldwide due to the complications that arise from its persistence among school-going adolescents. This study explored the causes of bullying among grades 8 and 9 in one secondary school in Amatole East District, Eastern Cape Province, South Africa. This qualitative study employed constructivist paradigm and a case study design. It utilised interviews to elicit data from 15 purposefully sampled participants. This study was informed by Travis Hirschi's 1968 Social Control Theory, and I used Braun and Clark's thematic analysis steps to analyse and interpret the data. The study found that bullying is triggered by jealousy and envy among learners, inadequate school furniture, family environment, physical attributes, lack of moral education, lack of sexual orientation education, and age differences among learners. Therefore, the study concluded that in order to detect the causes of bullying among grade 8 and 9 learners, teachers must apply Social Control Theory in the school environment by establishing consistent and supportive teacher-learner relationships to easily identify learners' behavioural changes and promote support, peer relationships, and unity among learners. This will reduce internal motivation that leads them to initiate bullying and violate other learners' rights. Additionally, the findings of this study will enable school stakeholders to develop intervention strategies, including disciplinary measures for learners, providing sexual orientation education, and involving parents in their efforts to manage bullying among grades 8 and 9 learners.

Cultivating leaders for primary health care: A revised approach for transformative development.

Family physicians require leadership skills to strengthen team-based primary care services. Interviews with South African district managers confirmed the need to develop leadership skills in family physicians. The updated national programmatic learning outcomes for South African family physician training were published in 2021. They sparked the need for curriculum renewal at the University of Cape Town's Division of Family Medicine. A review of the leadership and governance module during registrar training showed that the sessions were perceived to be content heavy with insufficient opportunities for reflection. Following a series of stakeholder engagements, the module convenors co-designed a revised module that was blueprinted on the updated learning outcomes. The module incorporates a group coaching style, facilitating learning through reflection on one's experiences. The revised module was implemented in 2022. It aims to provide a transformative learning experience centred on students' perceptions of themselves as leaders, as well as professional identity formation and resilience building. This short report describes preliminary insights from the revised module's developmental phase and forms part of an ongoing iterative evaluation process.Contribution:Family physicians should lead across all their defined roles. Formal and informal learning opportunities are needed to facilitate their growth as leaders and help them to meet the health needs of communities served by an evolving health care system. This short report describes an example of a revised postgraduate module on leadership and governance, which may be of value to clinician educators and academic departments exploring innovative methods for the African region.

Associations between Household Food Insecurity and Depressive Symptomology among Adolescent Girls and Young Women during the COVID-19 Pandemic in South Africa

Evidence suggests an association between food insecurity and depressive symptomatology; however, little is known about the association between adolescent girls and young women (AGYW) in the context of COVID-19. This study aimed to investigate the relationship between household food insecurity (HFI) and depressive symptomology among AGYW in South Africa during the COVID-19 pandemic. Secondary data analysis was conducted using cross-sectional data collected from the HERStory2 study conducted during the COVID-19 pandemic. The data were collected from 515 AGYW (aged 15–24 years) recruited from six South African districts using a demographic detail and socio-economic questionnaire as well as the Center for Epidemiological Studies Depression (CESD-10) Scale. Data were fitted using a multi-variable robust Poisson regression model and controlled for sociodemographic and health factors. The results suggest that the majority of the sample of AGYW were 20 years old, with 74% exposed to HFI and 30.29% experiencing depressive symptomology. AGYW exposed to HFI were 1.80 times at risk of depressive symptomology compared to those from food-secure households [adjusted risk ratio (aRR): 1.80; 95% CI: 1.35–2.42, p < 0.0001)]. Future pandemic-preparedness strategies should incorporate screening for HFI as a means to identify AGYW who may require psychosocial support.

Prevalent Clinical Assessments of HIV Positive Infants in a South African District Hospital

Prevalent Clinical Assessments of HIV Positive Infants in a South African District Hospital

Cultural Ramifications on the Educability of Pregnant and Parenting Learners at Four South African High Schools

The study investigated how the socio-cultural and traditional practices of school-based education duty-bearers influenced the educational access and participation of pregnant and parenting learners (PPLs) who chose to continue with schooling after falling pregnant. Using a qualitative case study research design, four high schools with high rates of girl pregnancy from one South African education district were purposively selected. The participants included 8 school governing body (SGB), 8 school management team (SMT), 8 pregnant-monitoring teachers (PMT), 8 class teachers, 8 PPLs and 8 mainstream learners who schooled with PPLs. Data were collected through individual interviews for PPLs for their confidentiality, and focus group interviews for all the other participants. Study results indicated that due to cultural, traditional perceptions and practices, the South African national education policy measures on the prevention and management of learner pregnancy which allows schoolgirls to return to school after giving birth was loosely observed and implemented at the schools. The reasons for these are; a) Negative attitudes of teachers and mainstream to PPLs; b) Domestication of motherhood and childrearing by community; c) Mythological discernment of PPLs by mainstream learners; d) Character contamination; and e) Femininity as a negative label on PPLs in a formal school setting. Thus, from the findings, it is recommended that school-based duty bearers be trained on democratic education policy frameworks and their implementation strategies, to benefit the vulnerable children such as PPLs, among others.

Exploring the value of ecosystem services at health clinic gardens in a South African context

Ecosystem services (ESs) valuation is important for advancing biodiversity objectives and investing in green infrastructure (GI) establishment. Little is known about the potential of health clinic gardens (HCGs) to provide ESs and their potential values. This study sought to determine the plant and bird species composition and potential value of ESs provided by 32 HCGs in two South African district municipalities. HCG sizes range from 513.0m2 to 13531.0m2 and each had at least one micro-garden. Among the 312 plant species observed across all HCGs, 60% were exotic. The small HCGs had 31 ± 3.6 different plant species per garden, compared to the medium-sized (32 ± 3.7) and large ones (49 ± 5.2). Provisioning ESs from the observed species were prominent with 17.4 ± 1.16 species potentially used for general well-being, 13.66 ± 1.08 as potential food plants, and 11.91 ± 0.93 potentially raw materials. Trees in HCGs were estimated to sequester up to 163481.87 kg of carbon from trees covering an area of up to 9620.80m2. Approximately 1390.70 ± 427.50m2 of HCG space had the potential to provide a habitat for plants and birds, and 11 bird species were observed across all HCGs. Sixty-three bird nests encountered in 18 HCGs are believed to belong to the Passer domesticus. HCGs resemble other types of gardens like home and domestic gardens, and their rich plant biodiversity positions them as ideal ecosystems to benefit even the most vulnerable members of society. They provide an opportune platform for knowledge upscaling in the cultivation and use of plant species as a supplement of primary healthcare and food security issues in the summer months to the rural, urban, and peri-urban poor in the Global South.

A sustainable differentiated funding model for South African district municipalities

Background: South African district municipalities supply, inter alia, basic social goods in order to realise socio-economic rights and promote sustainable development in their local communities. This requires adequate funding, which may be in the form of own generated revenue and intergovernmental transfers. However, despite legislated functions, many district municipalities are regarded as financially distressed and unable to deliver on their constitutional mandates.Aim: This study sought to develop a sustainable differentiated funding model for district municipalities that will enable them to deliver on their constitutional mandates.Methods: This empirical study followed a positivist paradigm and used questionnaires to solicit the views of selected municipal officials from all district municipalities on the efficacy of the current funding model against the key principles that underpin a successful funding framework for South African municipalities.Results: The results of this study indicated that the funding district municipalities receive and generate is not in line with their constitutional mandates, which in turn, negatively affects their financial condition. Thus, there is a necessity to reconstruct the current funding model.Conclusion: This study recommends a clear specification of C1 and C2 district municipal powers and functions, and that the current funding model change from applying a blanket approach and rather consider the different geographical areas and circumstances for C1 and C2 district municipalities.Contribution: This empirical study contributes to the broader body of scientific knowledge on the local government financial governance by addressing the funding model for South African district municipalities in a practical manner.

Healthcare provisions associated with multiple HIV-related outcomes among adolescent girls and young women living with HIV in South Africa: a cross-sectional study.

Adolescent girls and young women (AGYW) living with HIV experience poor HIV outcomes and high rates of unintended pregnancy. Little is known about which healthcare provisions can optimize their HIV-related outcomes, particularly among AGYW mothers. Eligible 12- to 24-year-old AGYW living with HIV from 61 health facilities in a South African district completed a survey in 2018-2019 (90% recruited). Analysing surveys and medical records from n = 774 participants, we investigated associations of multiple HIV-related outcomes (past-week adherence, consistent clinic attendance, uninterrupted treatment, no tuberculosis [TB] and viral suppression) with seven healthcare provisions: no antiretroviral therapy (ART) stockouts, kind and respectful providers, support groups, short travel time, short waiting time, confidentiality, and safe and affordable facilities. Further, we compared HIV-related outcomes and healthcare provisions between mothers (n = 336) and nulliparous participants (n = 438). Analyses used multivariable regression models, accounting for multiple outcomes. HIV-related outcomes were poor, especially among mothers. In multivariable analyses, two healthcare provisions were "accelerators," associated with multiple improved outcomes, with similar results among mothers. Safe and affordable facilities, and kind and respectful staff were associated with higher predicted probabilities of HIV-related outcomes (p<0.001): past-week adherence (62% when neither accelerator was reported to 87% with both accelerators reported), clinic attendance (71%-89%), uninterrupted ART treatment (57%-85%), no TB symptoms (49%-70%) and viral suppression (60%-77%). Accessible and adolescent-responsive healthcare is critical to improving HIV-related outcomes, reducing morbidity, mortality and onward HIV transmission among AGYW. Combining these provisions can maximize benefits, especially for AGYW mothers.

User Satisfaction with Primary Health Care Rehabilitation Services in a South African Metropolitan District.

Rehabilitation services are critical to improve health outcomes, particularly at community level within primary healthcare settings. As groups with an interest in the health system, rehabilitation service users' and caregivers' involvement in various aspects of health system strengthening is important for healthcare planning and evaluation. This study aimed to explore rehabilitation service users' perceptions of the rehabilitation services and their effect on their functioning in the Johannesburg Metropolitan District. A qualitative study was conducted using purposive sampling of participants attending rehabilitation at nine provincially funded clinics. Semi-structured interviews were conducted, and data were analysed using reflexive thematic analysis. The findings revealed the theme of happy with rehabilitation services and five associated categories, namely (1) service provider actions, (2) service organisation, (3) service user actions, (4) service access, and (5) service outcomes. The participants expressed overall satisfaction with their experiences of rehabilitation services, highlighting the importance of effective communication, patient-centred care, strong therapeutic relationships, and active patient engagement to achieve positive outcomes. This study provides the evidence for maintaining and extending rehabilitation at the PHC level in support of the health policy changes proposed for South Africa.

Building Consensus on the Point-of-Care Ultrasound Skills Required for Effective Healthcare Service Delivery at District Hospitals in South Africa: A Delphi Study

Background: Despite the widespread availability of ultrasound machines in South African district hospitals, there are no guidelines on the competency in point-of-care ultrasound (POCUS) use required by generalist doctors in this setting. This study aimed to define the required POCUS competencies by means of consensus via the Delphi method. Methods: An online Delphi process was initiated in June 2022, using the existing American Academy of Family Physicians’ ultrasound curriculum (84 skillsets) as the starting questionnaire. Panelists were selected across the country, including two from district hospitals in each province and two from each academic family medicine department in South Africa (N = 36). In each iterative round, the participants were asked to identify which POCUS skillsets were essential, optional (region-specific), or non-essential for South African district hospitals. This process continued until consensus (&gt;70% agreement) was achieved on all of the skillsets. Results: Consensus was achieved on 81 of the 84 skillsets after 5 iterative rounds (96.4%), with 3 skillsets that could not achieve consensus (defined as &lt;5% change over more than 2 consecutive rounds). The final consensus identified 38 essential, 28 optional, and 15 non-essential POCUS skillsets for the South African district hospital context. Conclusions: The list of essential POCUS skillsets provided by this study highlights the predominance of obstetric- and trauma-based skillsets required for generalist healthcare workers in South African district hospitals. The findings will require priority setting and revalidation prior to their implementation across the country.

Using Vhavenda Traditional Entertainment to Curb HIV Spread in the Rural South African District

Purpose. This study explored the use of traditional entertainment as a means of curbing human immunodeficiency virus (HIV) spread in the Vhembe district of South Africa. Engaging in cultural dances like tshikona, tshifasi, tshigombela, malende, davha, and musangwe keeps the youth grounded, making it less likely that they will engage in unprotected sexual intercourse. Methods. This qualitative study utilized an ethnographic design. The study was conducted in rural villages in Vhembe district, Limpopo province in South Africa. Eighteen participants consisted of Vhavenda traditional leaders and chiefs who met the selection criteria were purposively selected to participate in the study. The sample size was determined by data saturation. Semistructured face-to-face interviews were used to collect data, guided by an interview guide. Four observations were done concurrently with the interviews. Interviews were audio-recorded, and field notes were taken. Ethnographic content analysis was used to analyze the data collected. Results. The results indicate that Vhavenda traditional entertainments like tshigombela and tshikona can be used in reducing and managing the spread of HIV, whereas malende, tshifasi, davha, and musangwe have the potential to spread and increase incidences of HIV. Conclusion. The traditional entertainment such as tshigombela and tshikona can be utilized as they instill good morals. Malende, tshifasi, davha, and musangwe can be repatterned and modified. Traditional entertainments, if properly utilized, can add to the strategies of reducing the new incidences of HIV.

Mixed-methods cross-sectional study of the prevention of vertical HIV transmission program users unaware of male partner’s HIV status, in six South African districts with a high antenatal HIV burden

BackgroundElimination of vertical HIV Transmission (VHT) and maternal deaths are global health priorities. Male involvement is one of the most important factors that influences women’s decisions, including the uptake of Prevention of vertical HIV transmission (P-VHT). We sought to understand not knowing a male partner’s HIV status (MPHIVs) amongst women using services to prevent vertical HIV transmission in six South African districts with high antenatal HIV burden.MethodsA mixed-methods cross-sectional study was conducted in six South African districts, and data collected through face-to-face interviews with women and focus group discussions (FGDs) with women or male partners. The quantitative data were analyzed using STATA SE-17.0 and an inductive approach was used for qualitative data analysis.ResultsOverall, 28.7% of women were unaware of their MPHIVs, while 25.3% and 46.0% knew the MPHIVs was positive or negative, respectively. In multivariable logistic regression, single marital status and unplanned pregnancy increased the odds of not knowing a MPHIVs while a woman’s disclosure of her HIV status to the male partner reduced the odds. FDGs highlighted complexities around MPHIVs disclosure, e.g., reluctance to test for HIV and potential interventions including healthcare worker (HCW) assisted HIV disclosure.ConclusionUser-informed interventions to address MPHIVs non-disclosure amongst women of child-bearing age, particularly those at risk of unstable sexual partners and unplanned pregnancies, should be strengthened.

Managing Local Health System Interdependencies: Referral and Outreach Systems for Maternal and Newborn Health in Three South African Districts

In complex health systems, referral and outreach systems (ROS) are formal strategies for connecting and managing interdependencies between facilities in service delivery pathways. Well-functioning maternal and newborn ROS are critical to successful outcomes, and therefore, a good lens through which to examine the management of local interdependencies. We conducted a qualitative study of maternal–newborn ROS, involving interviews with 52 senior, middle, and frontline managers, in three health districts of three different provinces in South Africa. We analyse the differences in functioning of ROS as an interplay of setting (urban, rural), individual facility strengths and weaknesses, the quality of emergency medical services (EMS), and the wider provincial strategic and organisational context. ROS are strengthened by sub-district governance arrangements that recognise and enable connectedness—in particular, between primary health care and district hospital services; by informal, day-to-day communication and collaboration across levels and professions; and by hybrid clinical–managerial players as system brokers and systems thinkers. We also identify leverage points, places where small shifts could have wider system effects, most notably in the design and functioning of EMS, and in addressing small, but significant bottlenecks in supply chains in lower level facilities that negatively impact the system as a whole.

Expanding Community Health Worker decision space: learning from a Participatory Action Research training intervention in a rural South African district

BackgroundWhile integral to decentralising health reforms, Community Health Workers (CHWs) in South Africa experience many challenges. During COVID-19, CHW roles changed rapidly, shifting from communities to clinics. In the contexts of new roles and re-engineered primary healthcare (PHC), the objectives were to: (a) implement a training intervention to support local decision-making capability of CHWs; and (b) assess learning and impacts from the perspectives of CHWs.MethodsCHWs from three rural villages (n = 9) were trained in rapid Participatory Action Research (PAR) with peers and community stakeholders (n = 33). Training equipped CHWs with tools and techniques to convene community groups, raise and/or respond to local health concerns, understand concerns from different perspectives, and facilitate action in communities and public services. CHWs’ perspectives before and after the intervention were gained through semi-structured interviews. Data were collected and analysed using the decision space framework to understand local actors’ power to affect devolved decision-making.ResultsCHWs demonstrated significant resilience and commitment in the face of COVID-19. They experienced multiple, intersecting challenges including: limited financial, logistical and health systems support, poor role clarity, precarious employment, low and no pay, unstable organisational capacity, fragile accountability mechanisms and belittling treatment in clinics. Together, these restricted decision space and were seen to reflect a low valuing of the cadre in the system. CHWs saw the training as a welcome opportunity to assert themselves as a recognised cadre. Regular, spaces for dialogue and mutual learning supported CHWs to gain tools and skills to rework their agency in more empowered ways. The training improved management capacity, capabilities for dialogue, which expanded role clarity, and strengthened community mobilisation, facilitation and analysis skills. Development of public speaking skills was especially valued. CHWs reported an overall ‘tripe-benefit’ from the training: community-acceptance; peer support; and dialogue with and recognition by the system. The training intervention was recommended for scale-up by the health authority as an implementation support strategy for PHC.ConclusionsLack of recognition of CHWs is coupled with limited opportunities for communication and trust-building. The training supported CHWs to find and amplify their voices in strategic partnerships, and helped build functionality for local decision-making.

Models using private general practitioners to provide caesarean deliveries at five South African district public hospitals: insights for public-private contracting for obstetric care in rural areas

ABSTRACT Background Harnessing of private sector resources could play an important role in efforts to promote universal access to safe obstetric care including caesarean delivery in low- and middle-income countries especially in rural contexts but any such attempt would need to ensure that the care provided is appropriate and patterns of inappropriate care, such as high caesarean delivery rates, are not reproduced for the entire population. Objective To examine the contracting arrangements for using private general practitioners to provide caesarean delivery services in rural district hospitals in South Africa. Method We utilised a mixed-method study design to examine the contracting models adopted by five rural district hospitals in the Western Cape, South Africa. Between April 2021 and March 2022, we collected routine data from delivery and theatre registers to capture the profile of deliveries and utilisation of contracted private GPs. We also conducted 23 semi-structured qualitative interviews with key stakeholders to explore perceptions of the contracting arrangements. Results All five hospitals varied in the level of use of private general practitioners and the contracting models (three private in-sourcing models – via locum agencies, sessional contracts, and tender contracts) used to engage them. Qualitative interviews revealed insights related to the need for flexibility in the use of contractual models to meet local contextual needs, cost implications and administrative burden. Conclusion Structured appropriately, private public partnerships can fill important gaps in human resources in rural district hospitals. Policy makers should look to developing a ‘contracting framework’ which requires compliance with a set of underlying principles but allows for flexibility in developing context specific contracting arrangements. These underlying principles should include a ‘risk’ based delivery model, adherence to public sector- evidence-based protocols, time-based rather than per delivery/type of delivery remuneration models, group liability arrangements, and processes to monitor outcomes.

Challenges faced by curriculum advisors when offering curriculum support to schools in rural South Africa

Many stakeholders have severe concerns about providing curriculum support to schools. South African districts have minimal authority beyond planning and focusing objectives on district settings, but they are in charge of implementing all areas of educational operations, including curriculum, funds, and resources. Curriculum support has come under scathing criticism from teachers and principals who describe it as difficult and unsustainable. From a qualitative standpoint, coupled with the case study research design, this study used a purposive sample to select 15 (n = 15) participants. Data were collected through literature reviews and the application of semi-structured Key Informant Interviews and analysed using Thematic Analysis. The results of the study include understaffing of curriculum advisors, heavy workloads, incompetence, a lack of skill and pedagogical training that are requisite for the task, and a time constraint to handle curriculum challenges. This paper aims to investigate challenges faced by curriculum advisors when offering curriculum support to schools in the Waterberg District in the Limpopo Province of South Africa. This study concludes that adequate operational resources should be made available since they can improve everyone's access to high-quality teaching and learning resources. It is recommended that adequate funding be made available to address the district's financial issues so that curriculum advisors can easily provide curriculum support.

To queue or not to queue: Facility managers and mental health care users' experiences of integrated health care in a rural South African district.

A key feature of South Africa's state health care strategy since 1994 has been the development and expansion of services towards integrated health care at primary health care level. Within the new system, emphasis has been on the integration of patients with mental health care needs with other patients where multiple health conditions and needs would be addressed simultaneously. As part of a larger study into mental health care in a predominantly rural district, we investigated the experiences of facility managers and mental health service users in rural clinics within the system of care. We were interested both in their views as to the advisability of the integrated model and the ways in which they managed any challenges they may have experienced within the system at local level. Data were collected through once-off semi-structured interviews with facility managers and mental health care service users to gather qualitative information. Narratives were transcribed and translated into English. Transcriptions were imported to Atlas.ti 22 and analysed through Thematic Analysis. The integration of mental health care into routine primary health services poses challenges to treatment delivery and to patients who come for treatment. Our study also suggests resegregating mental health care as a possible solution to facilitate service delivery and treatment to service users. This research provided first insights into facility managers' and service users' views of integrated mental health care at primary health care level in this district. While mental health care services have been expanded and integrated into primary health care over recent years, the system may not have been as streamlined as in other parts of the country. The integration of mental health into primary health care can pose various challenges to facilities, health care providers, and mental health service users. Managers in these constrained circumstances have observed that resegregating mental health care from physical treatment, as in the past, may be deemed more effective for health care provision and reception. Generalised integration of mental health treatment with physical care should be approached with caution unless there is wider scale provisioning and greater organisational change.

Evaluating use of mass-media communication intervention ‘MTV-Shuga’ on increased awareness and demand for HIV and sexual health services by adolescent girls and young women in South Africa: an observational study

ObjectiveTo investigate the effect of exposure to MTV Shuga:Down South’ (MTVShuga-DS) during the scale-up of combination HIV-prevention interventions on awareness and uptake of sexual reproductive health (SRH) and HIV-prevention services...

EXPLORING PHYSICS TEACHERS’ TECHNOLOGICAL, PEDAGOGICAL AND CONTENT KNOWLEDGE AND THEIR LEARNERS’ ACHIEVEMENT IN ELECTRICITY

The technological, pedagogical and content knowledge (TPACK) framework was developed incorporating content, pedagogical and technological knowledge. Studies used TPACK constructs and reported on teachers’ TPACK and student learning, but none explored the correlation between teachers’ TPACK and the achievement of their learners. This research followed an exploratory correlational research design involving 1423 Grade 11 learners and their 42 Physics teachers in a South African district after electricity was taught. A self-report questionnaire may not truly measure teachers’ TPACK, therefore, learners’ perceptions of their teachers’ use of technology were explored. The correlation between the Physics teachers’ TPACK and the achievement of their learners in electricity was established. Four validated research instruments were used, namely, the Learner Electricity Achievement Test (LEAT), the Learner Confirmatory Questionnaire (LCQ), the Teachers’ Technological, Pedagogical and Content Knowledge Questionnaire (T-TPACKQ) and the Learners’ Confirmation of the Teachers’ Technological, Pedagogical and Content Knowledge Questionnaire (LC-T-TPACKQ). Findings indicate a statistically significant difference between teachers’ views of their TPACK and the views of their learners. The correlation between teachers’ TPACK and the achievement of their learners was not statistically significant. These results can influence the professional development of teachers in respect of the use of technology in teaching. Keywords: electricity teaching, student achievement, learner views, technological pedagogical and content knowledge (TPACK), teacher views

Who is Exposed to HIV Prevention Interventions? An Assessment of Associated Factors Among Adolescent Girls and Young Women in South Africa

This study examined the prevalence of HIV risk factors and their association with intervention exposure among adolescent girls and young women (AGYW) living in six South African districts in which a combination HIV-prevention intervention was being implemented. A cross-sectional household survey was conducted from 2017 to 2018 among a representative sample of AGYW aged 15–24 years living in the six districts. We used an electronic questionnaire for self-reported demographic and behavioural questions and blood samples were taken to confirm HIV status in the laboratory. Chi-Squared tests and multivariate binary logistic regression were used to examine associations between demographic characteristics, HIV acquisition and transmission risk factors and the likelihood of participating in any of the key components of the combination HIV-prevention intervention. Among the 4399 participants, 45.3% reported inconsistent condom use with casual partner and 46.6% with a main partner. Almost half of participants (47.8%) had participated in one or more components of the HIV-prevention intervention, and in a multivariate logistic regression, those reporting a higher number of HIV risk behaviours were no more (or less) likely to participate. Participants who were not in high school were significantly less likely to have participated in the intervention compared to those still in high school, when adjusting for age and HIV risk factors. The barriers to access and uptake of combination HIV prevention interventions among AGYW who are out of the education system need to be explored and combination HIV prevention interventions and implementation strategies need to be tailored to reach this population.