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

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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)

school selection and allocation
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 )
study design
Study Design

Control

F1

F2

6 months

6 months

F2

F1

Intervention

Intervention

Booster

12 months

analysis
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)
use of gee xtgee
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
schematic diagram of follow up rate
Schematic diagram of follow up rate

Baseline

5091

308 lost (6.0%)

Months 6 (F1)

4783

413 lost (8.6%)

Months 12 (F2)

4370

baseline comparison
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)
sexual activity and initiation
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
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

incidence of sexual debut among male adolescent by intervention status
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

correlation and covariate structure
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

conclusions
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
further analysis
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