PMID- 36962830
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230327
IS  - 2767-3375 (Electronic)
IS  - 2767-3375 (Linking)
VI  - 3
IP  - 2
DP  - 2023
TI  - Preliminary effectiveness and implementation outcomes of the IMARA-South Africa 
      sexual health intervention on adolescent girls and young women: A pilot 
      randomized trial.
PG  - e0001092
LID - 10.1371/journal.pgph.0001092 [doi]
LID - e0001092
AB  - Family-based interventions may help reduce the risk of HIV and other sexually 
      transmitted infections (STI) among adolescent girls and young women (AGYW) in 
      sub-Saharan Africa but few have been tested. We examined the preliminary 
      effectiveness and implementation outcomes of Informed, Motivated, Aware, and 
      Responsible Adolescents and Adults-South Africa (IMARA-SA), an evidence-based 
      intervention for South African AGYW (15-19 years) and their female caregivers. We 
      piloted IMARA-SA in the Western Cape using an individually randomized 
      experimental design and average follow-up at 11 months. Primary outcomes were HIV 
      Testing and Counselling (HTC) uptake, STI incidence (gonorrhea, chlamydia), and 
      pre-exposure prophylaxis (PrEP) uptake. Secondary outcomes were self-reported 
      sexual risk behavior (condom use at last sex, consistency of condom use, 
      substance use during sex, and number of sexual partners) and PrEP adherence. We 
      examined four implementation outcomes: reach, feasibility, acceptability, and 
      fidelity. Data from 59 AGYW (mean = 17.2 years) were analyzed at baseline (n = 29 
      from IMARA-SA, 30 from a health promotion control group). At follow-up, 51 (86%) 
      completed surveys and 39 (66%) presented for HTC, STI testing, and/or PrEP. 
      Compared to controls, fewer IMARA-SA participants tested positive for an STI (22% 
      versus 38%), more IMARA-SA participants took up PrEP (68% versus 45%), and four 
      of five secondary outcomes favored the IMARA-SA group at follow-up. These 
      differences did not reach statistical significance. HTC uptake at follow-up was 
      100% in both groups. All AGYW-FC dyads agreed to participate in the study 
      (reach). In the IMARA-SA group, 76% of dyads completed the intervention 
      (feasibility), and over 76% of acceptability ratings from AGYW and their FC had 
      the highest Likert rating. Fidelity of intervention delivery was 95%. IMARA-SA is 
      a promising strategy for reducing HIV/STI risk among South African AGYW. We found 
      strong evidence of reach, feasibility, acceptability, and fidelity. A fully 
      powered randomized controlled trial is warranted. Trial registration: Clinical 
      trials.gov registration number: NCT05504954.
CI  - Copyright: This is an open access article, free of all copyright, and may be 
      freely reproduced, distributed, transmitted, modified, built upon, or otherwise 
      used by anyone for any lawful purpose. The work is made available under the 
      Creative Commons CC0 public domain dedication.
FAU - Merrill, Katherine G
AU  - Merrill KG
AUID- ORCID: 0000-0001-5308-4154
AD  - Department of Medicine, Center for Dissemination and Implementation Science, 
      University of Illinois Chicago, Chicago, IL United States of America.
FAU - Atujuna, Millicent
AU  - Atujuna M
AD  - Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
FAU - Emerson, Erin
AU  - Emerson E
AD  - Department of Medicine, Center for Dissemination and Implementation Science, 
      University of Illinois Chicago, Chicago, IL United States of America.
FAU - Blachman-Demner, Dara
AU  - Blachman-Demner D
AD  - Office of Behavioural and Social Sciences, National Institutes of Health, 
      Bethesda, MD, United States of America.
FAU - Bray, Bethany C
AU  - Bray BC
AD  - Institute for Health Research and Policy, University of Illinois Chicago, 
      Chicago, IL, United States of America.
FAU - Bekker, Linda-Gail
AU  - Bekker LG
AD  - Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
FAU - Donenberg, Geri R
AU  - Donenberg GR
AD  - Department of Medicine, Center for Dissemination and Implementation Science, 
      University of Illinois Chicago, Chicago, IL United States of America.
LA  - eng
SI  - ClinicalTrials.gov/NCT05504954
PT  - Journal Article
DEP - 20230215
PL  - United States
TA  - PLOS Glob Public Health
JT  - PLOS global public health
JID - 9918283779606676
PMC - PMC10022073
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/03/25 06:00
MHDA- 2023/03/25 06:01
PMCR- 2023/02/15
CRDT- 2023/03/24 18:19
PHST- 2022/08/16 00:00 [received]
PHST- 2023/01/16 00:00 [accepted]
PHST- 2023/03/24 18:19 [entrez]
PHST- 2023/03/25 06:00 [pubmed]
PHST- 2023/03/25 06:01 [medline]
PHST- 2023/02/15 00:00 [pmc-release]
AID - PGPH-D-22-01037 [pii]
AID - 10.1371/journal.pgph.0001092 [doi]
PST - epublish
SO  - PLOS Glob Public Health. 2023 Feb 15;3(2):e0001092. doi: 
      10.1371/journal.pgph.0001092. eCollection 2023.