Background: Adolescent girls are at disproportionately high-risk for HIV and unintended pregnancy. Effective interventions to increase uptake of HIV testing and contraceptives are urgently needed.

CIDRZ, in partnership with the Ministry of Health (MoH), the Ministry of General Education (MoGe), Grassroot Soccer, the University of California-San Francisco and the United States National Institutes of Health (NIH), collaborated to assess the impact of a school based, sport focused sexual and reproductive health curriculum.  

Method: The study team conducted a cluster-randomized controlled trial in 46 schools in Lusaka, Zambia to evaluate the SKILLZ intervention, a peer-led, sports-based intervention to empower adolescent girls, on HIV self-testing and contraceptive use. We surveyed a random sample of over 1000 Grade 11 girls at baseline, 6, and 12 months to measure self-reported uptake of HIV/SRH products and services. We examined a) HIV testing and any contraceptive method within the previous 6 months, (b) HIV testing by modality and contraceptive uptake by method, and (c) new adoption and discontinuation. 

Findings: Between March 2021 and June 2022, 1,019 girls were enrolled from 23 control schools and 1,134 enrolled from 23 intervention schools; 79% of surveyed girls in intervention schools participated in SKILLZ, 71% attended at least 8/12 sessions to “graduate”. At 6 months, 600 (59%) participants in intervention schools and 307 (37%) participants in control schools had tested for HIV within the previous 6 months, 281 (37%) participants in intervention schools and 200 (30%) participants in control schools had used contraception within the previous 6 months. These effects on HIV testing and contraception were sustained at 12 months.

Summary: SKILLZ increased uptake of HIV testing and contraception among in-school adolescent girls. Further research is needed to understand treatment mechanisms and heterogeneity to tailor the intervention before implementation at scale.

Acknowledgements: Thanks to the girls who participated, the parents who consented, the teachers, coaches and counsellors who assisted and the MoH and MoGE for their support and guidance and for allowing us to conduct this important study. A special thanks too to the United States National Institutes of Health (NIH) and to the study team for all their hard work.

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