SKILLZ干预措施对赞比亚少女和年轻女性性与生殖健康赋权的影响：一项整群随机对照试验的结果

The impact of the SKILLZ intervention on sexual and reproductive health empowerment among Zambian adolescent girls and young women: results of a cluster randomized controlled trial.

作者信息

Sheira Lila A, Mulubwa Chama, Chiu Calvin, Chipungu Jenala, Coakley Chelsea, Smith Helene, Upadhyay Ushma D, Chilambe Chansa, Chibwe Besa, Pry Jake M, Mkandawire Boyd, Musonda Maggie, Moore Carolyn Bolton, Liu Jenny

机构信息

Institute for Health & Aging, School of Nursing, University of California, San Francisco, USA.

Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.

出版信息

Reprod Health. 2025 Jun 5;22(1):95. doi: 10.1186/s12978-025-02046-6.

DOI:10.1186/s12978-025-02046-6

PMID:40474217

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12142864/

Abstract

BACKGROUND

Zambian adolescent girls and young women (AGYW, age 15–24) experience a disproportionate burden of HIV and unintended pregnancy. Sports-based interventions, which affect sexual health behaviors via improving sexual and reproductive empowerment, may be an innovative and effective approach for promoting HIV and unintended pregnancy prevention. We sought to evaluate the impact of a peer-led, sports-based intervention on sexual and reproductive empowerment among in-school Zambian adolescent girls and young women.

METHODS

Data come from the ‘SKILLZ’ study, a cluster randomized controlled trial evaluating the impact of a peer-led, sports-based health education program. Sexual and reproductive empowerment, a secondary outcome of SKILLZ, was measured via the 23-item Sexual and Reproductive Empowerment for adolescents and young adults scale (range 0–92, higher = more sexual and reproductive empowerment) three times over approximately 24 months. We conducted a difference-in-differences analysis to evaluate intervention impact over time.

RESULTS

The study enrolled 2,153 AGYW (1134 intervention; 1019 control) across 46 secondary schools in Lusaka. Median age at baseline was 17; participants were largely unmarried (96%), with 20% reporting any sexual activity. By endline, nearly 40% reported being sexually active. Between baseline and midline, attending an intervention school was associated with a 6.21-point increase in overall score calculated using the imputed sample (standard error [SE]: 0.75, < 0.001) compared to being in a control school (6.75% change). At endline, being in an intervention school was associated with a 5.12-point increase in the Sexual and Reproductive Empowerment overall score (SE: 0.71, < 0.001; 5.57% change)). Among sexually active AGYW, being in an intervention school was associated with a 7.78-point (SE: 1.17, < 0.001) and 4.64-point increase (SE: 0.93, < 0.001) from the baseline to the midline and endline rounds, respectively (8.46% and 5.04% change, respectively).

CONCLUSION

The intervention moderately impacted Sexual and Reproductive Empowerment scores; results were magnified among sexually active AGYW. Given adolescence is a critical period for sexuality and gender programming, as well as for sexual debut, empowerment interventions at schools may support downstream sexual health behaviors that will impact the life-course of AGYW.

TRIAL REGISTRATION

This study was registered in ClinicalTrials.gov (NCT04429061) on March 17th, 2020.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12978-025-02046-6.

摘要

背景

赞比亚的少女和年轻女性（年龄在15 - 24岁之间）承受着不成比例的艾滋病病毒感染负担和意外怀孕问题。基于体育活动的干预措施，通过增强性健康和生殖健康方面的自主权来影响性健康行为，可能是促进预防艾滋病病毒感染和意外怀孕的一种创新且有效的方法。我们旨在评估一项由同伴主导、基于体育活动的干预措施对赞比亚在校少女和年轻女性性健康和生殖健康自主权的影响。

方法

数据来自“SKILLZ”研究，这是一项整群随机对照试验，评估由同伴主导、基于体育活动的健康教育项目的影响。性健康和生殖健康自主权是SKILLZ的次要结果，通过针对青少年和年轻成年人的23项性健康和生殖健康自主权量表（范围为0 - 92，分数越高表明性健康和生殖健康自主权越高）在大约24个月内进行了三次测量。我们进行了差分分析以评估随时间变化的干预效果。

结果

该研究在卢萨卡的46所中学招募了2153名少女和年轻女性（1134名干预组；1019名对照组）。基线时的中位年龄为17岁；参与者大多未婚（96%），20%报告有过任何性活动。到终期时，近40%报告有性活跃行为。在基线和中期之间，与就读于对照学校相比，就读于干预学校的学生使用推算样本计算的总体得分增加了6.21分（标准误差[SE]：0.75，P < 0.001）（变化6.75%）。在终期时，就读于干预学校的学生性健康和生殖健康自主权总体得分增加了5.12分（SE：0.71，P < 0.001；变化5.57%）。在有性活跃行为的少女和年轻女性中，就读于干预学校的学生从基线到中期和终期分别增加了7.78分（SE：1.17，P < 0.001）和4.64分（SE：0.93，P < 0.001）（分别变化8.46%和5.04%）。