A Comprehensive HIV Prevention Package for South African Adolescent Girls and Young Women: IMARA SA
Condition: Sexually Transmitted Infection; Hiv
MeSH terms: Sexually Transmitted Diseases
Study type: Interventional

Summary: 
      Programs which go beyond individual-level behavior change to reduce HIV and STI infections
      among adolescent girls and young women in sub-Saharan Africa are essential to meet global HIV
      targets. Informed, Motivated, Aware and Responsible Adolescents and Adults- South Africa
      (IMARA-SA) is an evidence-based HIV-prevention intervention for adolescent girls and young
      women (AGYW) and their female caregivers, which has been adapted for a South African
      audience. This pilot study will assess feasibility in preparation for a randomized controlled
      trial (RCT). Additionally, the pilot will examine the preliminary effectiveness of IMARA-SA
      in reducing sexually transmitted infections (STI) and increasing uptake of HIV testing and
      counseling (HTC) and pre-exposure prophylaxis (PrEP) at follow-up among AGYW. About 60
      AGYW-FC dyads will be enrolled and randomized to IMARA-SA or a health-promotion control arm.
      Following randomization, the dyads will participate in an ~2-day group workshop (~10 hours),
      which includes joint and separate mother and daughter activities. AGYW and FC will complete
      baseline assessments and follow-up assessments approximately 6 months later. Assessments will
      include surveys, STIs testing (for chlamydia and gonorrhea), and uptake of HTC and a 1-month
      PrEP prescription. Additionally, the intervention's implementation (e.g., acceptability) will
      be explored.
    


Intervention name(s): IMARA-SA (intervention group); Health promotion control group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The IMARA-SA intervention aligns with an ecological framework, emphasizing the intersection of individual, social, and structural determinants of women's sexual health and behavior. Separate FC and AGYW groups run simultaneously and cover parallel content, while joint activities enhance FC credibility as a resource for HIV/STI prevention and facilitate practice of communication skills. Interventionists use interactive and experiential activities. IMARA-SA's goals and motto emphasize strong FC-AGYW relationships, sisterhood, community empowerment, and motivation for HIV prevention, and build group cohesion. FC and AGYW sign a pact to confirm commitment to the program. At the end of Workshop Day 1, participants receive homework to complete during the week. Woven throughout IMARA-SA is the impact of mental health issues, alcohol and drug use, and violence on HIV-risk.; The health promotion control intervention is a family-based intervention previously delivered to families in SA and translated into isiXhosa. The intervention promotes healthy living by encouraging good nutrition, exercise, and violence reduction. It will be delivered in the same format as IMARA and will be identical in length and intensity.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Adolescent girl and young women-female caregiver (AGYW-FC) dyads will be randomized to the IMARA-SA intervention arm or a health promotion control arm matched in time and intensity. IMARA-SA and the health promotion program will be delivered as group interventions.
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: HIV prevention; Adolescent girls and young women; South Africa; Mother-daughter intervention