Combination HIV prevention for adolescent girls and young women in South Africa
Background
South Africa has the world’s largest HIV epidemic, with adolescent girls and young women (AGYW) aged 15–24 years disproportionately affected. We compare HIV prevalence and selected HIV prevention outcomes among AGYW living in areas where the My Journey Programme, a combination HIV prevention intervention, was implemented vs. comparison areas.
Methods
We conducted a post-implementation, non-randomised cluster comparison study with a post-test-only design. Between February and May, 2024, we undertook a cross-sectional household survey among AGYW aged 15–24 years in 12 intervention and 12 matched comparison subdistricts across eight South African provinces. Matched comparison subdistricts were selected on sociodemographic characteristics and pre-intervention HIV prevalence. Participants completed an electronic questionnaire and provided dried blood spot specimens for HIV testing. Primary and secondary outcomes were HIV prevalence, knowledge of HIV status, and uptake of HIV and pregnancy prevention services, respectively. Odds ratios (ORs) were estimated using adjusted multilevel mixed-effects logistic regression.
Findings
Among 5025 participants, 2638 were from the intervention and 2387 from the comparison areas. HIV prevalence was 9.5% in the intervention and 10.4% in the comparison group (OR: 0.88; 95% CI: 0.46–1.70). Knowledge of HIV status was higher in the intervention group (84.7% vs. 80.5%; OR 1.46, 1.05–2.03). Ever-use of pre-exposure prophylaxis (PrEP) was also higher among participants in the intervention group (26.4% vs. 13.0%; OR: 2.19; 95% CI: 1.11–4.30).
Interpretation
Participants living in the intervention areas were associated with higher PrEP coverage and greater knowledge of HIV status, but not with lower HIV prevalence. These findings indicate programme-associated differences rather than causal effects.