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AIM

Effect of prepare Intervention on sexual initiation and condom use among adolescents in Dar es S alaam: Preliminary analysis. AIM. Dar PREPARE Intervention aimed at examining the effect of the Intervention on; 1. Delaying sexual debut

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  1. Effect of prepare Intervention on sexual initiation and condom use among adolescents in Dar es Salaam: Preliminary analysis

  2. AIM Dar PREPARE Intervention aimed at examining the effect of the Intervention on; 1. Delaying sexual debut (Incidence of sexual debut/ action planning to delay sex) 2. Practice of safer sexual behavior (Use of condom during last sex/Action plan to use condom)

  3. School selection and allocation • 38 schools randomly selected t represent urban and semi-urban Dar es salaam • Matched by size and location • Allocated to the two arms (19 Intervention and 19 control schools )

  4. Study Design Control F1 F2 6 months 6 months F2 F1 Intervention Intervention Booster 12 months

  5. Analysis • Compare baseline socio-demographic and outcome scales by intervention status • Examine and test best correlation structure for repeated measures ( use QIC) • Examine change in mean scores overtime using extended generalized estimating equation modeling (xtgee)for repeated measures (Use QIC)

  6. Use of GEE (xtgee) • Repeated measures are positively correlated • Correlation decrease by measurement occasion • GEE- form of Generalized Linear Mixed Model • Excellent for balanced design • Change in link function accommodate Count (Poisson) or Binary (binomial) outcome • Handle more then two measurement occasions • Control for correlation

  7. Schematic diagram of follow up rate Baseline 5091 308 lost (6.0%) Months 6 (F1) 4783 413 lost (8.6%) Months 12 (F2) 4370

  8. Baseline comparison • A total 5091 participants in baseline • Participants from control schools were significantly older than those from intervention school (12.39 versus 12.43; p=0.020) • More from standard 6 (64.1% versus 61.8%; p=0.025) • All other variables comparable (except HAVES, communication with friends and parents)

  9. Baseline mean scale comparison between Intervention and control schools

  10. Sexual activity and initiation • Significantly large proportion of intervention group participants were sexually active (10.7% Intervention vs 8.9% control, p=0.026)

  11. Incidence of sexual debut among female adolescent by intervention status Female Intervention N=1052 at risk Control N=1113 at risk 60 new initiation Incidence 11/100 PYAR 52 new initiation Incidence 9.0/100PYAR Month 6 75 new initiation Incidence 7/100PYAR 114 new initiation Incidence 9.7/100PYAR Month 12 RR =1.6, p=0.024 *Assumption: Debut occurred mid follow time

  12. Incidence of sexual debut among male adolescent by intervention status Male Intervention N=1158 at risk Control N=1213 at risk 65 new initiation Incidence 10.9/100 PYAR 78 new initiation Incidence 12.4/100PYAR Month 6 87 new initiation Incidence 7.2/100PYAR 126 new initiation Incidence 10.0/100PYAR Month 12 RR =1.9, p<0.001 *Assumption: Debut occurred mid follow time

  13. Change over time in mean scales for action plan to delay sex

  14. Change over time in mean scales for action plan to use condom

  15. Correlation and covariate structure pwcorrsex0 sex1 sex3 | sex0 sex1 sex3 sex0 | 1.0000 sex1 | 0.7000 1.0000 sex3 | 0.5791 0.8272 1.0000 corrsex0 sex1 sex3, cov | sex0 sex1 sex3 -------------+--------------------------- sex0 | .088426 sex1 | .080242 .148585 sex3 | .074042 .137103 .184882

  16. Intervention effect on the mean score : Female

  17. Intervention effect on the mean score : Male

  18. Conclusions • The intervention was effective in; • Promoting action plan to delay sex for both sex • delaying sexual initiation for both male and female adolescents • Condom use among male but not among women

  19. Further analysis • Examine intervention effectiveness in promoting other aspect of safer sex-multiple sexual partners • Effective on communication, self efficacy etc • Predictors of observed positive outcomes

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