Impact Evaluation of a School-Based Sexuality and HIV Prevention Education Activity in South Africa
Condition: HSV-2 Infection; HIV Infections; Pregnancy Related
MeSH terms: Infections; Communicable Diseases
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate the impact of the new South African Department of
      Basic Education (DBE) sexuality and HIV education program that uses scripted lesson plans and
      supporting activities and will be implemented by Education Development Center (EDC). The
      primary outcomes are the incidence of HSV-2 or pregnancy among a cohort of learners in grade
      8 and followed for two years in two provinces of South Africa.
    

Detailed description: 
      This evaluation focuses on the HIV and sexual and reproductive health (SRH) content of the
      Government of South Africa life orientation (LO) Curriculum. In 2010, the Department of Basic
      Education (DBE) undertook assessments of their LO program and learned that while young people
      who participated in the program had improved knowledge and attitudes, the program was not
      being implemented uniformly, such that the results were inconsistent across schools and
      learners. To address these concerns, DBE, with support from the United States Agency for
      International Development (USAID) and the United States President's Emergency Plan for AIDS
      Relief (PEPFAR), developed scripted lesson plans (SLP) to strengthen the SRH content and
      standardize implementation across schools; these SLP were paired with supporting activities
      to address fidelity in the curriculum's delivery. The SLP were integrated in the LO program,
      with most of the lessons offered in the first half of the school year. The lessons were
      developed for grades 4-6, 7-9, and 10-12. This evaluation focuses on the curricula for grades
      7-9 and 10-12. There are eight lessons for grade 7, eight for grade 8, 11 for grade 9, and 10
      for grade 10. Notably, there were delays in getting DBE approvals for release of the grade-10
      curriculum.

      A key component of the program is that all LO teachers are trained on the new materials prior
      to implementation. Since 2015, USAID/PEPFAR has provided technical support to DBE for program
      roll out in priority provinces and districts that have the highest HIV incidence and
      prevalence. Technical support includes educator training on the new SLP and considerations of
      approaches for scale-up beyond the initial districts. Support for the first phase of
      implementation and testing was led by Education Development Center, with funding from USAID.

      The goal of the proposed impact evaluation is to assess the impact of the LO program on
      students over time. The primary evaluation question is: What is the effect of the scripted
      lesson plans and supporting activities on the incidence of HSV-2 or pregnancy after two years
      among a cohort of girls enrolled in grade 8 at intervention schools compared to a cohort of
      girls in grade 8 at control schools providing the current life skills program (i.e., the
      standard of practice)?

      The secondary evaluation questions include:

        -  What is the effect of the scripted lesson plans and supporting activities on knowledge,
           attitudes, school retention, and self-reported risk behavior, HIV testing, and completed
           referrals for health services at the end of 8th, 9th, and 10th grade among a cohort of
           girls first interviewed in grade 8 and among a cross-section girls and boys interviewed
           in grade 8, grade 9 and grade 10?

        -  If there is a reduction in the primary outcome, does the intervention work by increasing
           school retention, or is the effect independent of school retention?
    

Intervention name(s): School-based sexuality and HIV prevention scripted lesson plans
Intervention type(s): Behavioral
Intervention description(s): The revised life orientation content and implementation approach were designed to address gaps in prior implementation of the sexuality and HIV education content. By using scripted lesson plans and training teachers to use these, it was thought that students would get better information and lessons on the material important for HIV prevention.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized cluster design whereby schools were assigned to intervention or control schools before the trial began.
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: HIV prevention; School-based programming; Pregnancy prevention; South Africa; Genital herpes