Africa Health Research Institute, KwaZulu-Natal, South Africa.
Institute for Global Health, University College London, London, UK.
BMJ Open. 2023 May 19;13(5):e062804. doi: 10.1136/bmjopen-2022-062804.
OBJECTIVE: To investigate the effect of exposure to MTV Shuga:Down South' (MTVShuga-DS) during the scale-up of combination HIV-prevention interventions on awareness and uptake of sexual reproductive health (SRH) and HIV-prevention services by adolescent girls and young women (AGYW). DESIGN: One longitudinal and three cross-sectional surveys of representative samples of AGYW. SETTING: AGYW in four South African districts with high HIV prevalence (>10%) (May 2017 and September 2019). PARTICIPANTS: 6311 AGYW aged 12-24. MEASURES: Using logistic regression, we measured the relationship between exposure to MTV Shuga-DS and awareness of pre-exposure prophylaxis (PrEP), condom use at last sex, uptake of HIV-testing or contraception, and incident pregnancy or herpes simplex virus 2 (HSV-2) infection. RESULTS: Within the rural cohort 2184 (85.5%) of eligible sampled individuals were enrolled, of whom 92.6% had at least one follow-up visit; the urban cross-sectional surveys enrolled 4127 (22.6%) of eligible sampled individuals. Self-report of watching at least one MTV Shuga-DS episode was 14.1% (cohort) and 35.8% (cross-section), while storyline recall was 5.5% (cohort) and 6.7% (cross-section). In the cohort, after adjustment (for HIV-prevention intervention-exposure, age, education, socioeconomic status), MTVShuga-DS exposure was associated with increased PrEP awareness (adjusted OR (aOR) 2.06, 95% CI 1.57 to 2.70), contraception uptake (aOR 2.08, 95% CI 1.45 to 2.98) and consistent condom use (aOR 1.84, 95% CI 1.24 to 2.93), but not with HIV testing (aOR 1.02, 95% CI 0.77 to 1.21) or acquiring HSV-2 (aOR 0.92, 95% CI 0.61 to 1.38). In the cross-sections, MTVShuga-DS was associated with greater PrEP awareness (aOR 1.7, 95% CI 1.20 to 2.43), but no other outcome. CONCLUSIONS: Among both urban and rural AGYW in South Africa, MTVShuga-DS exposure was associated with increased PrEP awareness and improved demand for some HIV prevention and SRH technologies but not sexual health outcomes. However, exposure to MTVShuga-DS was low. Given these positive indications, supportive programming may be required to raise exposure and allow future evaluation of edu-drama impact in this setting.
目的：调查在扩大组合 HIV 预防干预措施期间，接触 MTV Shuga：Down South'（MTVShuga-DS）对青少年女孩和年轻妇女（AGYW）对性生殖健康（SRH）和 HIV 预防服务的认识和采用的影响。
设计：对四个南非高 HIV 流行地区（>10%）（2017 年 5 月和 2019 年 9 月）具有代表性的 AGYW 样本进行了一项纵向和三项横断面调查。
参与者：6311 名年龄在 12-24 岁的 AGYW。
措施：使用逻辑回归，我们衡量了接触 MTV Shuga-DS 与对暴露前预防（PrEP）、最近一次性行为中使用避孕套、接受 HIV 检测或避孕措施以及意外怀孕或单纯疱疹病毒 2（HSV-2）感染的意识之间的关系。
结果：在农村队列中，2184 名符合条件的被抽样个体中，有 2184 名（85.5%）被招募，其中 92.6%至少有一次随访；城市横断面调查招募了 4127 名（22.6%）符合条件的被抽样个体。自我报告观看至少一集 MTV Shuga-DS 的比例为 14.1%（队列）和 35.8%（横断面），而故事情节回忆的比例为 5.5%（队列）和 6.7%（横断面）。在队列中，经过调整（HIV 预防干预暴露、年龄、教育、社会经济地位）后，接触 MTVShuga-DS 与 PrEP 意识提高有关（调整后的比值比（aOR）2.06，95%置信区间（CI）1.57 至 2.70），避孕措施的采用（aOR 2.08，95% CI 1.45 至 2.98）和一致使用避孕套（aOR 1.84，95% CI 1.24 至 2.93），但与 HIV 检测（aOR 1.02，95% CI 0.77 至 1.21）或获得 HSV-2（aOR 0.92，95% CI 0.61 至 1.38）无关。在横断面调查中，MTVShuga-DS 与更高的 PrEP 意识相关（aOR 1.7，95% CI 1.20 至 2.43），但没有其他结果。
结论：在南非城乡 AGYW 中，接触 MTVShuga-DS 与 PrEP 意识的提高以及对某些 HIV 预防和 SRH 技术的需求增加有关，但与性健康结果无关。然而，接触 MTVShuga-DS 的比例很低。鉴于这些积极迹象，可能需要提供支持性计划以提高接触率，并允许在这一环境中对教育戏剧的影响进行未来评估。
Front Glob Womens Health. 2024-4-18
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