Study Sites
HIV and pregnancy testing
SECONDARY
Between 2018 and 2019, all 42 secondary schools located in the study area, a single health subdistrict within the Western Cape Province, were randomized to be a control school (n=20), intervention school (n=20), or nonparticipating school (n=2). For logistical feasibility, study implementation was split over 2 years, with 20 schools (10 intervention, 10 control) engaged in 2018 (cohort 1) and 20 schools (10 intervention, 10 control) engaged in 2019 (cohort 2). Eligible learners within each school were required to be female, not pregnant, and in school grades 8–10 (approximately aged 13–17 years). Pregnancy testing was included, as pregnancy incidence was a primary study outcome. Pregnancy tests were conducted in private by trained adolescent-friendly health care professionals, and all participants who received a positive pregnancy test were counseled and referred for further care if needed. The program was advertised by poster and in-class promotion by study staff. Between 70 and 100 learners per school self-selected to participate. Participants were followed prospectively for a period of 8 months, with a total sample size target of 2,800.School and community engagement before study commencement was extensive, involving stakeholder consultations at the provincial, district, and individual school levels. Each school principal nominated a “teacher champion” who acted as the school liaison between the implementing team, school staff, and participants. At that time, the implementing research team had an established presence in all participating schools through a larger national women and girls program that included the delivery of SRH education and services in schools. A Youth Community Advisory Committee affiliated with the study site that had advised on several studies and clinical trials was consulted during the protocol development process. As part of the curriculum development process, a group of adolescent learners from participating schools were engaged in pilot SKILLZ sessions. Their feedback was incorporated into the curriculum design, notably changing the sport component of SKILLZ from solely soccer (football) to include other activities, such as yoga and stretching.Intervention schools shared similar learner demographic profiles, with no significant differences in participant characteristics between control and intervention schools or between cohorts 1 and 2. Thirty-eight schools completed the study (18 in cohort 1 with 9 intervention and 9 control schools; 20 in cohort 2 with 9 intervention and 11 control schools). Two schools withdrew mid-implementation due to a change in local policy that was interpreted as disallowing external providers to provide health care services, such as HIV and pregnancy testing, during study visits on school premises. One control school in cohort 1 requested to delay participation due to building renovations on the school premises and, as such, was included in cohort 2.Of 2,791 participants enrolled, 1,344 (48.15%) participants were included in the intervention arm and 1,447 (51.84%) participants were included in the control arm; 44.39% (1,239) participated in cohort 1 and 55.61% (1,552) participated in cohort 2.