Youth-friendly sexual health services and peer support for improved sexual and reproductive health outcomes among adolescents and young adults in South Africa: results of a factorial randomized controlled trial
Youth-friendly sexual health services and peer support for improved sexual and reproductive health outcomes among adolescents and young adults in South Africa: results of a factorial randomized controlled trial
Background: adolescents and young adults in South Africa have high burdens of STIs and unintended pregnancy. We evaluated the impact of peer support and/or expanded sexual and reproductive health (SRH) services on STIs, contraception, and pregnancy in rural KwaZulu-Natal, South Africa.
Methods: we analyzed secondary outcomes from a 2x2 factorial randomized controlled trial conducted March 2020-August 2022 among 16-29-year-olds, comparing: 1) enhanced Standard of Care (SoC): access to mobile youth-friendly HIV prevention(AYFS); 2) SRH: self-collected STI testing and referral to AYFS with expanded SRH services; 3) Peer-support: peer navigator facilitation of AYFS attendance; 4) SRH+peer-support. At 12 months all participants were offered STI testing; female participants self-reported contraceptive use and pregnancy.
Results: among 1743 trial participants (51% female), 927 (53%) had 12-month STI results; 209 (22.5%) tested positive: 163 (17.6%) chlamydia, 54 (5.8%) gonorrhea, 44 (4.8%) trichomoniasis. STI prevalence was somewhat lower among those exposed to peer-support (aOR adjusted for sex, age, location: 0.77, 95%CI 0.56-1.06) or SRH (aOR 0.74, 0.56-1.06) and, compared to SoC, was reduced in those exposed to both (aOR 0.59, 0.38-0.94). In SRH arms, 64/469 (13.6%) had a new STI at 12 months, with no difference by peer-support (p=0.97). Among females, 336/634 (53.0%) reported using contraception and 47/667 (7.1%) pregnancy, with little difference by study arm.
Conclusions: peer support and STI testing with expanded SRH each had no more than small effects on STIs, contraception, or pregnancy. Combined or more intensive interventions, e.g., repeat screening, enhanced partner notification, and deeper understanding of structural drivers, are needed.
Jarolimova, Jana
7f02035d-5a5b-4ed5-a2fb-c88c40368eb4
Busang, Jacob
f6352c2f-ccc2-4db1-8977-d9ded173e633
Chimbindi, Natsayi
c518d13f-6c0b-4eb2-92f5-89d260eeba87
Okesola, Nonhlanhla
0a55eb44-591c-4c9f-85a1-bd9268d845fc
Smit, Theresa
27eb61ce-0175-46ad-b4f5-bb47b319adbe
Harling, Guy
0403b83a-0afe-472c-a184-7a6357afe29a
Mcgrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Copas, Andrew J.
10c9d680-f510-4969-ab9a-9e2a61568cb8
Seeley, Janet
f3106c01-ac91-4ffc-945a-6db3558fd8eb
Baisley, Kathy
5fe8c276-d9d2-4bb6-91a3-8acd38a5151f
Shahmanesh, Maryam
d88581c9-0ef2-4506-b8d3-d72682936a09
Jarolimova, Jana
7f02035d-5a5b-4ed5-a2fb-c88c40368eb4
Busang, Jacob
f6352c2f-ccc2-4db1-8977-d9ded173e633
Chimbindi, Natsayi
c518d13f-6c0b-4eb2-92f5-89d260eeba87
Okesola, Nonhlanhla
0a55eb44-591c-4c9f-85a1-bd9268d845fc
Smit, Theresa
27eb61ce-0175-46ad-b4f5-bb47b319adbe
Harling, Guy
0403b83a-0afe-472c-a184-7a6357afe29a
Mcgrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Copas, Andrew J.
10c9d680-f510-4969-ab9a-9e2a61568cb8
Seeley, Janet
f3106c01-ac91-4ffc-945a-6db3558fd8eb
Baisley, Kathy
5fe8c276-d9d2-4bb6-91a3-8acd38a5151f
Shahmanesh, Maryam
d88581c9-0ef2-4506-b8d3-d72682936a09
Jarolimova, Jana, Busang, Jacob, Chimbindi, Natsayi, Okesola, Nonhlanhla, Smit, Theresa, Harling, Guy, Mcgrath, Nuala, Copas, Andrew J., Seeley, Janet, Baisley, Kathy and Shahmanesh, Maryam
(2025)
Youth-friendly sexual health services and peer support for improved sexual and reproductive health outcomes among adolescents and young adults in South Africa: results of a factorial randomized controlled trial.
Sexually Transmitted Diseases.
(doi:10.1097/OLQ.0000000000002203).
Abstract
Background: adolescents and young adults in South Africa have high burdens of STIs and unintended pregnancy. We evaluated the impact of peer support and/or expanded sexual and reproductive health (SRH) services on STIs, contraception, and pregnancy in rural KwaZulu-Natal, South Africa.
Methods: we analyzed secondary outcomes from a 2x2 factorial randomized controlled trial conducted March 2020-August 2022 among 16-29-year-olds, comparing: 1) enhanced Standard of Care (SoC): access to mobile youth-friendly HIV prevention(AYFS); 2) SRH: self-collected STI testing and referral to AYFS with expanded SRH services; 3) Peer-support: peer navigator facilitation of AYFS attendance; 4) SRH+peer-support. At 12 months all participants were offered STI testing; female participants self-reported contraceptive use and pregnancy.
Results: among 1743 trial participants (51% female), 927 (53%) had 12-month STI results; 209 (22.5%) tested positive: 163 (17.6%) chlamydia, 54 (5.8%) gonorrhea, 44 (4.8%) trichomoniasis. STI prevalence was somewhat lower among those exposed to peer-support (aOR adjusted for sex, age, location: 0.77, 95%CI 0.56-1.06) or SRH (aOR 0.74, 0.56-1.06) and, compared to SoC, was reduced in those exposed to both (aOR 0.59, 0.38-0.94). In SRH arms, 64/469 (13.6%) had a new STI at 12 months, with no difference by peer-support (p=0.97). Among females, 336/634 (53.0%) reported using contraception and 47/667 (7.1%) pregnancy, with little difference by study arm.
Conclusions: peer support and STI testing with expanded SRH each had no more than small effects on STIs, contraception, or pregnancy. Combined or more intensive interventions, e.g., repeat screening, enhanced partner notification, and deeper understanding of structural drivers, are needed.
Text
youth_friendly_sexual_health_services_and_peer.529
- Accepted Manuscript
More information
e-pub ahead of print date: 21 July 2025
Additional Information:
For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.
Identifiers
Local EPrints ID: 505440
URI: http://eprints.soton.ac.uk/id/eprint/505440
ISSN: 0148-5717
PURE UUID: e293b938-dc1c-4d0c-a59b-4b1bafbcd124
Catalogue record
Date deposited: 08 Oct 2025 16:50
Last modified: 09 Oct 2025 01:52
Export record
Altmetrics
Contributors
Author:
Jana Jarolimova
Author:
Jacob Busang
Author:
Natsayi Chimbindi
Author:
Nonhlanhla Okesola
Author:
Theresa Smit
Author:
Guy Harling
Author:
Andrew J. Copas
Author:
Janet Seeley
Author:
Kathy Baisley
Author:
Maryam Shahmanesh
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
