DOI: 10.14749/1576056969
title: Evaluating an incentivised behaviour change intervention (IBCI), 2018-2019: Young women, aged 19-24 years - King Cetshwayo district, KwaZulu Natal

description: Description: 
 Topics covered in the questionnaire are: socio-demographic and family characteristics, participation in other programmes/ interventions, relationship status, knowledge of HIV/AIDS and sexually transmitted diseases, socially accepted practices, HIV prevention knowledge, pregnancy history, intimate partner violence, sexual risk behaviour, attitudes towards HIV, self-efficacy, social support systems and body-image.

 The data set for dissemination contains 3061 cases and 509 variables.
Abstract: 
 Young women and girls (YWG) bear a disproportionate burden of HIV infection in South Africa; a country where an estimated 7.1 million people were living with HIV in 2016. A significant number of new infections (37%) occur in young women aged 15-24. This age cohort is also four times more vulnerable to HIV infection and is infected at earlier ages than their male peers. Although the epidemic in South Africa is characterised as generalized, there are specific at-risk groups who have higher HIV prevalence than the national average, including black African females aged 20-34 years with an HIV prevalence of 31.6%. South Africa's National Strategic Plan 2017-2022 identifies YWG as key affected populations at risk of HIV transmission and as critical beneficiaries of HIV prevention interventions. In South Africa, KwaZulu-Natal has the highest prevalence of HIV. Given this risk profile, the KwaZulu-Natal Province, with funding from the Global Fund is implementing a behaviour change empowerment incentivised intervention for young women aged 19-24 years. We conducted an intervention evaluation using a pre-post cohort quasi-experimental design to evaluate the impact and effectiveness of the CPC intervention programme in improving behavioural outcomes in a sample of young women aged 19-24 years old. The objectives were firstly to measure whether exposure to and participation in CPC intervention is associated with reduction in HIV risk behaviour among young women aged 19-24 years and secondly to measure whether exposure to and participation in CPC intervention will lead to increased uptake of SRH services among young women aged 19-24 years.
description: Face-to-face interview
description: The target population for the project were young women between the ages of 19-24 years, attending the Cash plus care intervention in the King Cetshwayo District municipality and young women between the ages 19-24 years living in the Ugu Districtict municipality who were conveniently sample from community structures, such as war-rooms and churches, amongst others.
description: Quantitatively, this study uses a pre-post cohort quasi-experimental design. KCD is the intervention district, where 20,000 YWG will receive the CPC intervention; 1,000 of whom will also receive the RISE intervention. The uGu District is used as a matched comparison (or control) group and will receive assessments only. A mixed methods approach is used to evaluate both process outcomes and impact outcomes of the intervention. This includes quantitative components (surveys at baseline and endline), and qualitative components (diaries and interviews with beneficiaries, direct observations of workshop sessions, in-depth interviews and focus groups with service providers) as depicted below.

 Sample sizes were calculated according to what was required to undertake a comparative study based on a number of behavioural outcomes, including:

 The sample size was based on provincial prevalence estimates for antenatal clinic attending young women aged 20-24 years (Power=80 and Alpha=0.05) using power size estimation in STATA. Calculations are based on a 12 month behavioural intervention with expected moderate but significant change in behaviour between baseline and endline. Desired outcome is taken as reduction in HIV incidence, as such sample size is based on 2009-2013 KZN HIV prevalence estimates for young women aged 20-24 years old and a hypothesized 20% reduction post-intervention.

 A total of 3,000 participants will be screened and recruited into the study; 2500 participants in the intervention district (KCD) and 500 participants in the control district (uGu District).

 Intervention participants will be recruited from the King Cetshwayo District. The intervention beneficiaries will be recruited via ward councillors for enrolment in the intervention. The workshops will be conducted at 105 wards with 20-25 girls per workshop session. To reach a target of 20, 000 YWG, the implementers will need to conduct 800-1000 sessions. Therefore in each of the 105 wards, each session will be repeated between 8-10 times until the target is reached. Each session will be repeated over a 3 month period.

 For the evaluation, we will recruit 500 participants in each of 5 sub-districts in KCD, including 150 RISE participants across the district. A list of wards in each district will be developed and we will select 30 wards using random stratified sampling (6 wards per district). We will stratify according to contextual criteria, namely, rural, peri-urban and urban. We will sample participants across the 3 months until we reach our sample size to ensure that we get a range of participants, and not only early adopters. We will sample participants at workshop sessions. A list of workshop sessions in the randomly selected wards will be developed. Based on the number of sessions, we will sample every nth workshop, until our sample size is reached. Although workshops are envisaged to comprise 20-25 young women and girls, participant in the survey will be voluntary.

 For the control district, we will select 500 participants. The participants will be recruited through community structures, such as war-rooms and churches, amongst others. We will be careful to include participants from rural, peri-urban and urban communities.

 1. Unwanted pregnancies

 
 Utilization of SRH services
 
 Contraceptive use (dual protection)


 2. Reduction in risky sexual behaviour

 
 Male condom use
 
 Reduction in multiple concurrent sexual partners
 
 Discouraging age-disparate sexual partnerships