Creating a combination HIV and pregnancy prevention cascade to measure condom and contraception use among adolescent girls and young women in South African schools
1
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
2
Department of Psychology, University of Cape Town, Cape Town, South Africa
3
Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
4
Department of Social Policy & Intervention, University of Oxford, Oxford, South Africa
5
Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
6
Division of Infectious Diseases, Department of Internal Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
7
Division of Social and Behavioural Sciences, School of Public Health, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
In South Africa, HIV incidence and unintended pregnancy among adolescent girls and young women (AGYW) remain high, driven by shared biological, behavioural, and structural factors. This study examined AGYW’s uptake of and adherence to non-barrier contraceptives and dual condom–contraceptive use to identify key barriers and facilitators and inform prevention programming.
METHODS:
Baseline data collected between July and September 2022 were analysed as part of an evaluation of a combination HIV and pregnancy prevention programme implemented in 14 South African schools. Drawing on the HIV prevention cascade, a cascade describing knowledge, motivation, access, and effective use of condoms, contraceptives, and dual methods were constructed among AGYW who reported sexual activity in the past six months, not living with HIV, and not planning a pregnancy. Relationships between cascade steps were examined using path analysis. Barriers to and facilitators of motivation, access, and effective use were assessed using generalised linear models with a Poisson distribution (log link).
RESULTS:
For contraceptives, self-reported access was high (71%), while motivation (50%) and effective use (11%) were low. For dual methods, access (54%), motivation (35%), and effective use (3%) were lower. Knowledge was associated with all subsequent contraceptive cascade steps (p≤0.031), and motivation was associated with effective use (IRR=2.33; 95% CI: 1.22–4.48; p=0.015). Older age (IRR=1.11; 95% CI: 1.04–1.19; p=0.005) and having ever been offered contraceptives (IRR=1.38; 95% CI: 1.23–1.54; p<0.001) were associated with access. Belief that contraceptives prevent pregnancy was associated with motivation (IRR=1.88; 95% CI: 1.22–2.90; p=0.008). Parental communication about contraceptives was associated with motivation, access, and effective use (p<0.05).
CONCLUSIONS:
Despite relatively high access, substantial gaps in motivation and effective use of contraceptives and dual methods persist among AGYW. While school-based Safe Spaces provide an acceptable platform for sexual and reproductive health services, engaging parents may further strengthen uptake and adherence.
In South Africa, HIV incidence and unintended pregnancy among adolescent girls and young women (AGYW) remain high, driven by shared biological, behavioural, and structural factors. This study examined AGYW’s uptake of and adherence to non-barrier contraceptives and dual condom–contraceptive use to identify key barriers and facilitators and inform prevention programming.
METHODS:
Baseline data collected between July and September 2022 were analysed as part of an evaluation of a combination HIV and pregnancy prevention programme implemented in 14 South African schools. Drawing on the HIV prevention cascade, a cascade describing knowledge, motivation, access, and effective use of condoms, contraceptives, and dual methods were constructed among AGYW who reported sexual activity in the past six months, not living with HIV, and not planning a pregnancy. Relationships between cascade steps were examined using path analysis. Barriers to and facilitators of motivation, access, and effective use were assessed using generalised linear models with a Poisson distribution (log link).
RESULTS:
For contraceptives, self-reported access was high (71%), while motivation (50%) and effective use (11%) were low. For dual methods, access (54%), motivation (35%), and effective use (3%) were lower. Knowledge was associated with all subsequent contraceptive cascade steps (p≤0.031), and motivation was associated with effective use (IRR=2.33; 95% CI: 1.22–4.48; p=0.015). Older age (IRR=1.11; 95% CI: 1.04–1.19; p=0.005) and having ever been offered contraceptives (IRR=1.38; 95% CI: 1.23–1.54; p<0.001) were associated with access. Belief that contraceptives prevent pregnancy was associated with motivation (IRR=1.88; 95% CI: 1.22–2.90; p=0.008). Parental communication about contraceptives was associated with motivation, access, and effective use (p<0.05).
CONCLUSIONS:
Despite relatively high access, substantial gaps in motivation and effective use of contraceptives and dual methods persist among AGYW. While school-based Safe Spaces provide an acceptable platform for sexual and reproductive health services, engaging parents may further strengthen uptake and adherence.
| eISSN: | 2654-1459 |
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