1. PREPARE PROJECT Feedback Cape Town Nov 27 2013 Dar Es Salaam Site – Sylvia Kaaya 1

2. Introduction 38 Schools randomized into 19 intervention and 19 delayed intervention arms Two streams in each class 5 & 6 were randomly selected for intervention implementation (4 classes) Intervention: All learners in implementing classes 5 and 6 in the 19 intervention schools Evaluation: All learners in implementing classes 5 & 6 aged 12-14 years in the 19 intervention and delayed intervention schools 2

3. Introduction Three Programs components developed and implemented –A Classroom-based –A Peer-led –Youth friendly services Aimed to facilitate sustainable relationships between intervention schools and youth friendly services 3

4. Introduction Program objectives Behaviour change Delay sex initiation/ abstinence if sexually active Consistent condom use Proximal predictors Increased knowledge on HIV & protection Change attitudes & norms about delayed sex initiation and condom use Increased self-efficacy to delay sex initiation & use condoms 4

5. Introduction: Manuals 5

6. PROCESS EVALUATION 6

7. Objectives Implementation – Were planned activities correctly implemented? – What challenges existed in implementation? Quality – Were instructional methods and materials well received? – Were teachers having any difficulties in preparing lesson plans? – Were peer educators confident and prepared? Exposure/Involvement – Are students being exposed to each session/activity? – Are students participating during the sessions/activities? – Are students comfortable talking about sexuality and reproductive health with peers? Changed beliefs – Did the program have an impact on the way learners think about sexuality? 7

8. Data Sources Workbooks – key sections work done by learner and graded – Program fidelity and learners acceptability of the program – Analysis from random sample of 10% workbooks from each school Progress: Data entry SPSS Observation Forms – Assesses quality of implementation and involvement of learners – Planned at least 2 of each session observed; Have classroom (n=32), Peer sessions (n=16) and YFS (n=8) – Progress: Analysis matrices Interview Guides – narrative data – KII (Education Municipal office and Health workers) – FGD (exposed learners, Peer educators, teachers, head teachers, academic coordinators and Parents) Progress: Code book development and narrative entry to Nvivo Ver10 Teacher’s lesson plan forms and Peer leaders’ Diaries Progress: Analysis Weekly feed-back calls from implementing teachers – challenges and solutions 8

9. Performance Excellent schools: Team teaching Self innovation Sense of ownership among the teachers and students as well Cooperation and support from the head teachers office Morale of the teachers and the learners in implementing the program high Good peer educators who led well the peer sessions Average schools: No team teaching Low morale of the teachers and peer educators in implementation Little self innovation on how best to implement the program Low ability of the peer educators facilitation of the peer sessions Cooperation and support from the head teachers office Sense of ownership among the teachers and students as well Tools: Peer and Classroom Observation tools and Weekly call tool. Results: 0 poor school, 9 (47%) Excellent schools and 10 (53%) Average schools CAPE TOWN NOVEMBER 20139

10. OUTCOME EVALUATION 10

11. Summary of the impact evaluation study design IO1X1O2YO3 CO1O2O3X2 Pair-wise matching and randomization (schools) I – Intervention group C – Comparison group O1 – Baseline data collection O2 – First follow up data collection O3 – 2 nd follow up data collection x1 – Intervention y – Booster sessions X2 – Delayed intervention (January, 2014) 11

12. Baseline Invited 6,090 Recruited 5,573 388 Unable to participate Interviewed 5,185 72 DiscardedEntry 5,113 8 Double ID; 3 ID missing 3 less than 20% entered Final 5,099 121 (2%) Did not assent 312 (5%) Parents declined 105 (1.7%) Unable to read and write 12

13. Follow Up 1 (90.7% capture) Baseline 5099 Collected 4,653 12 Discarded during baseline Entered 4,641 12 Not in Baseline 3 Wrong ID Final 4,626 Baseline Vs FU1: 473 (9.3%) 13

14. Follow Up 2 (84.6% capture) Baseline 5099 Collected 4,325 3 Discarded (Error in completion) Entered 4,322 7 Duplicate ID Final 4,315 Baseline Vs FU2: 784 (15%) Lost to follow up FU1 Vs FU2: 311 (6.7%) Lost to follow up 14

15. INTERVENTION BOOSTER 15

16. Booster One-day in school activities developed by students Show cased a number of activities to other students, parents and community leaders Some of the activities included:- – Drama – Songs – Poem – Picture competition – Reproductive health talks from nurses 16

17. 17

18. DELAYED INTERVENTION 18

19. Delayed Intervention Delayed intervention is planned to start in January 2014 Formation of planning committee (n=8) Pairing of schools (Intervention and delayed intervention) Sharing of students, teachers and peer- educator manuals during implementation in the delayed intervention schools. 19

20. Acknowledgements Bergen Team –Leif and Annegreet Maastricht University –Hein De Vries –Matthijs Eggers 20

21. Dar Team Site PI: Sylvia Kaaya Co- PIs: Gad Kilonzo, Elia Mmbaga and Khalifa Mrumbi Coordinator & Research Fellow: Lusajo Kajula Intervention: Juliana Joachim Evaluation: Mrema Noel MSc. Applied Epidemiology: Dr. Prosper Njau 21

22. Ahsante Sana! 22