1. Families Matter! Program Increases Parent-Preadolescent Communication about Sex in Tanzania An Outcome Evaluation in Mtwara and Ruvuma Shoo T, Kamala B, Rosecrans K, Miller K, Al-Alawy H, Rwezahura P

2. Attribution and Disclaimer This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement No.1U2GGH001019-01. The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the CDC.

3. Background Young Tanzanians are at risk of HIV infection (THMIS 2011-12) –HIV prevalence among women 1.1% (15-17 years old) 6.6% (23-24 years old) –Comprehensive HIV knowledge (15-24 years old) 40% women 47% men –About half men & women aged 18-24 reported having sex before age 18 Studies from many countries, including Tanzania, suggest parents play an important role in preventing their children from engaging in risky sexual behavior

4. Families Matter! Program Curriculum FMP was implemented in Ruvuma (Subira ward) and Mtwara (Nanyamba ward)

5. Objective To evaluate whether Families Matter! Program (FMP) increases parent-preadolescent communication about sex in the two wards –Sexual education Heterosexual friendship Puberty Menstruation –Sexual risk reduction Abstinence Peer pressure Condoms Sex Reproduction Maturity required for sex Family planning HIV/AIDS Other sexually transmitted infections (STIs)

6. Methodology Pre-post program evaluation –1-3 weeks before FMP –3 months after FMP Structured questionnaire –Face-to-face interview –Administered separately to parent/ guardian and 9-12 year-old child Six questions in each domain –Each question scored 0-2 0 “No, never” 1 “Yes, once” 2 “Yes, more than once” Approved by the National Health Research Ethics Review Committee at the National Institute for Medical Research (Tanzania) and Centers for Disease Control and Prevention.

7. Data Analysis Analysis using SPSS v22 Descriptive statistics calculated to describe the study population Frequency of answers to each item calculated For each domain, score calculated –Cronbach’s alpha calculated >0.7 considered internally consistent McNemmers test and Wilcoxon signed-rank test (a non-parametric test) were used to compare baseline and post-intervention scores 797 parent-preadolescent pairs enrolled at baseline –658 (83%) completed post-intervention questionnaire

8. Results

9. MtwaraRuvumaTotal N (%) SexMale101 (30.7)84 (25.5)185 (28.1) Female228 (69.3)246 (74.5)474 (71.9) Age25-3498 (29.8)86 (26.1)184 (27.9) 35-44136 (41.3)119 (36.1)255 (38.7) 45-5464 (19.5)71 (21.5)135 (20.5) 55+31 (9.4)54 (16.4)85 (12.9) RelationshipParent 271 (81.9) 247 (74.8) 518 (78.6) Other 58 (18.1) 83 (25.2) 141 (21.4) Education None54 (16.4)40 (12.1) 94 (14.3) Primary260 (79.0)276 (83.6) 536 (81.3) Secondary + 15 (4.6)14 (4.2) 29 (4.4) OccupationFarmer317 (96.4)322 (97.6)639 (97.0) Others12 (3.6)8 (2.4)20 (3.0) Total 329 (100.0) 330 (100.0) 659 (100.0) Parent Socio-Demographic Characteristics

10. MtwaraRuvumaTotal N (%) SexMale152 (46.2)167 (50.6)319 (48.4) Female177 (53.8)163 (49.4)340 (51.6) Age9-10204 (62.0)176 (53.3)380 (57.7) 11-12125 (38.0)154 (46.7)279 (42.3) Total329 (100.0)320 (100.0)659 (100.0) Preadolescent Socio-Demographic Characteristics

11. Ever Talked about Sexual Education Topics

12. Ever Talked about Sexual Risk Reduction Topics

13. Baseline score Post- interven tion score Score difference Participa nts with score improvem ents Test for significa nce Median (Q1,Q3) Mean% P-value Sexual education Parent0 (0,1) 4 (1,10)4.658<0.0001 Preadolescent0 (0,1) 2 (0,6)2.954<0.0001 Sexual risk reduction Parent2 (0,2) 8 (4,8)5.281<0.0001 Preadolescent1 (0,2) 4 (2,8)3.256<0.0001 Baseline and Post-Intervention Communication Scores

14. Conclusions FMP increases parent-child communication –Sexual education –Sexual risk reduction May influence children to –Delay sexual debut –Reduce risky sexual behaviors and hence HIV new infections among youth

15. Acknowledgements FMP Participants MOHSW (NACP) TACAIDS RAS Ruvuma and Mtwara DED Songea WEO and VEO Head teachers Enumerators and supervisors T-MARC partners