Effect of prepare Intervention on sexual initiation and condom use among adolescents in Dar es...
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Effect of prepare Intervention on sexual initiation and condom use among adolescents in Dar es Salaam: Preliminary analysis
AIMDar 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)
School selection and allocation
38 schools randomly selected t represent urban and semi-urban Dar es salaamMatched by size and locationAllocated to the two arms (19 Intervention and 19 control schools )
Study Design
Control
Intervention
F1
F1
F2
F2
Intervention Booster
6 months 6 months
12 months
AnalysisCompare baseline socio-demographic and outcome scales by intervention statusExamine 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)
Use of GEE (xtgee)Repeated measures are positively correlatedCorrelation decrease by measurement occasionGEE- form of Generalized Linear Mixed Model
Excellent for balanced designChange in link function accommodate Count (Poisson) or Binary (binomial) outcomeHandle more then two measurement occasionsControl for correlation
Schematic diagram of follow up rate
Baseline
5091
Months 6 (F1)
4783
Months 12 (F2)
4370
308 lost (6.0%)
413 lost (8.6%)
Baseline comparisonA total 5091 participants in baselineParticipants 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)
Variable Intervention
Control
Mean difference
P-value
Action plan condom use 2.598 2.578 0.0198 0.4743
Action plan delayed sex 2.809 2.793 0.1529 0.6163
Self-efficacy Communicate with peer
2.266 2.225 0.0407 0.0678
Peer communication 1.646 1.606 0.03944 0.0946
Communication with friends 1.384 1.338 0.0465 0.0007
Communication with parents
1.338 1.305 0.0335 0.0328
Self-efficacy to delay sex 2.591 2.596 0.0046 0.8614
Self-efficacy to use Condom 2.439 2.479 0.0396 0.0930
Social norms condom use 3.352 3.407 0.0549 0.0518
Social norm delay sex 3.516 3.487 0.0297 0.2780
Attitude delay sex (negative)
2.321 2.297 0.0239 0.3343
Attitude delay sex (positive) 3.433 3.433 0.0002 0.9936
Puberty knowledge 1.504 1.503 0.0005 0.9445
Myth about condom 2.231 2.244 0.0127 0.4939
Haves 3.771 3.992 -0.2208 0.0003
Baseline mean scale comparison between Intervention and control schools
Sexual activity and initiation
Significantly large proportion of intervention group participants were sexually active
(10.7% Intervention vs 8.9% control, p=0.026)
Incidence of sexual debut among female adolescent by intervention status
Female
Month 6
Month 12
InterventionN=1052 at risk
ControlN=1113 at risk
60 new initiationIncidence 11/100 PYAR
52 new initiationIncidence 9.0/100PYAR
75 new initiationIncidence 7/100PYAR
114 new initiationIncidence 9.7/100PYAR
RR =1.6, p=0.024
*Assumption: Debut occurred mid follow time
Incidence of sexual debut among male adolescent by intervention status
Male
Month 6
Month 12
InterventionN=1158 at risk
ControlN=1213 at risk
65 new initiationIncidence 10.9/100 PYAR
78 new initiationIncidence 12.4/100PYAR
87 new initiationIncidence 7.2/100PYAR
126 new initiationIncidence 10.0/100PYAR
RR =1.9, p<0.001
*Assumption: Debut occurred mid follow time
Change over time in mean scales for action plan to delay
sex
Month 0 Month 6 Month 12
2.788
2.741
2.836
2.767
2.819
2.893
Change overtime in mean scale for action planning to delay
sex among Female adolescents
Control Intervention Month 0 Month 6 Month 12
2.748
2.813
2.858
2.8212.848
2.939
Change overtime in mean scale for action planning to delay sex among Male ado-
lescents
Control Intervention
Change over time in mean scales for action plan to use condom
Month 0 Month 6 Month 12
2.445
2.624 2.616
2.432
2.6172.658
Change in mean scale overtime for action
planning to use condom among Female adoles-
cents
Control Intervention
Month 0 Month 6 Month 12
2.655
2.687
2.719
2.661
2.698
2.728
Change in mean scale overtime for action plan-
ning to use condom among Male adolescents
Control Intervention
Correlation and covariate structure pwcorr sex0 sex1 sex3 | sex0 sex1 sex3 sex0 | 1.0000 sex1 | 0.7000 1.0000 sex3 | 0.5791 0.8272 1.0000
corr sex0 sex1 sex3, cov | sex0 sex1 sex3 -------------+--------------------------- sex0 | .088426 sex1 | .080242 .148585 sex3 | .074042 .137103 .184882
Intervention effect on the mean score : Female INTERVENTION CONTROLVariable Occasion Coefficient P-value Coefficient P-value
Action to delay sex baseline ref ref ref ref Month 6 0.0469 0.256 0.0526 0.237 Month 12 0.1055 0.033 0.0686 0.144 Group 0.1345 0.015 Action to use condom
baselineref ref ref ref
Month 6 0.172 <0.001 0.1916 <0.001 Month 12 0.143 0.001 0.1857 <0.001 Group 0.0174 0.678 Sexual initiation baseline ref ref ref ref Month 6 0.0746 <0.001 0.0694 <0.001 Month 12 0.148 <0.001 0.1318 <0.001 Group 0.1361 0.009 Condom use baseline ref ref ref ref Month 6 0.1727 <0.001 0.2660 <0.001 Month 12 0.2910 <0.001 0.3070 0.001 Group 0.0162 0.463
Intervention effect on the mean score : Male INTERVENTION CONTROL
Variable Occasion Coefficient P-value Coefficient P-valueAction to delay sex baseline ref ref ref ref Month 6 0.0839 0.004 0.1049 <0.001 Month 12 0.1497 <0.001 0.1562 <0.001 Group 0.003 0.633 Action to use condom
baseline ref ref ref ref Month 6 0.0729 0.048 0.0546 0.173 Month 12 0.1880 0.019 0.0926 0.033 Group 0.0740 0.0876 Sexual initiation baseline ref ref ref ref Month 6 0.0656 0.010 0.0272 0.530 Month 12 0.1249 0.007 0.0092 0.843 Group 0.1126 0.043 Condom use baseline ref ref ref ref Month 6 0.3209 <0.001 0.1484 0.025 Month 12 0.3694 <0.001 0.2672 <0.001 Group 0.2173 0.004
ConclusionsThe intervention was effective in;
Promoting action plan to delay sex for both sexdelaying sexual initiation for both male and female adolescentsCondom use among male but not among women
Further analysisExamine intervention effectiveness in promoting other aspect of safer sex-multiple sexual partnersEffective on communication, self efficacy etcPredictors of observed positive outcomes