Cape Town Young Women's Health CoOp
Condition: Condomless Sex; Human Immunodeficiency Virus (HIV); Sexually Transmitted Infections (STIs); Alcohol and Drug Use; Violence and Victimization; Access and Linkage to Healthcare; Education Advancement
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections; Sexually Transmitted Diseases; Immunologic Deficiency Syndromes
Study type: Interventional

Summary: 
      This two-arm cluster randomized trial tested a gender-focused comprehensive HIV testing and
      counselling (HTC) program, the Young Women's Health CoOp (YWHC) with a standard HTC program
      and targeted female adolescents (aged 16-19) who use substances and have dropped out of
      school. To evaluate the process, the study examined the feasibility of using peer role models
      as recruiters and co-facilitators of the intervention and monitored fidelity to the
      intervention. Efficacy of the intervention on behavioral and biological outcomes, and on
      linkages to health services, through follow-up visits conducted 6- and 12-months
      post-enrollment was also assessed.
    

Detailed description: 
      The purpose of this study was to test a gender-focused comprehensive HIV testing and
      counselling (HTC) program, the Young Women's Health CoOp (YWHC) with a standard HTC program
      in 24 disadvantaged communities in Cape Town, South Africa. The researchers conducted
      community-level randomization across the 24 communities with balanced recruitment from
      predominantly Black African and predominantly Coloured communities. The aims of the study
      were: Aim 1. To train and evaluate adolescent peer role models to conduct community outreach
      with established outreach workers to recruit 500 out-of-school, substance-using female
      adolescents aged 16 to 19 for HIV testing and counseling (HTC) and to co-facilitate a
      gender-focused comprehensive HTC program. Aim 2. To test the efficacy of a young women's
      gender-focused comprehensive HTC program for reducing substance use, victimization, and
      sexual risk behavior (primary outcomes) and improving access to effective treatment and
      support services through linkages to care (substance abuse treatment, HIV, sexually
      transmitted infections [STIs], antenatal and reproductive health as secondary outcomes)
      relative to standard HTC for adolescent females. The Young Women's Health CoOp has been
      adapted from the South African Women's Health CoOp (WHC) and the North Carolina Young Women's
      CoOp (YWC) which was found acceptable in focus groups and maintained all the core elements of
      the evidence-based intervention. For this study, the intervention was co-facilitated by
      trained staff from the local communities. The intervention consisted of two 1.5-hour group
      workshops (sessions), each having several modules that are usually administered a week apart:
      Workshop 1: Developmental Issues and Alcohol and Other Drugs; Gender, Problem-Solving and
      Conflict Negotiation, Violence and Values and Becoming a Powerful Young Woman: and Workshop
      2: STIs, HIV/AIDS, Prevention, Condoms and Role-play. After each session, each participant
      developed a risk-reduction personalized action plan (PAP). To maintain PAP goals and reduce
      decay of intervention effects over time, the staff conducted case management to help
      participants attain these personal goals. Participants completed baseline, 6-month follow-up
      and 12-month follow-up assessments, which included a survey and biological testing for
      substance use, pregnancy and HIV.
    

Intervention name(s): Young Women's Health CoOp (YWHC); Standard HTC
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants received HTC and engaged in a two-session gender-focused intervention. The intervention included information addressing the intersection of substance use, sexual risk, and violence through skill building, role-play, and rehearsal. The intervention also encouraged positive goal-seeking to access linkages to health care within the larger social ecological framework of where the young women live.; Participants received the standard HTC available in South Africa for this population.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Human Immunodeficiency Virus (HIV); HIV Testing and Counseling (HTC); Sexually Transmitted Infections (STIs); Substance Abuse; Gender Based Violence; Gang Violence; Victimization; Linkage to Care; Sexual Risk; Out-of-school Adolescents; Young Women