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Sport-based HIV prevention
• HIV remains pressing threat to young people– 34M infected, 2.5M new infections per year– About 35% of infections are among young people – Limited effectiveness of youth prevention efforts– Urgent need for effective prevention work
• Increasing use of sports-based HIV prevention– Dozens of organizations and funders across the world
• e.g. Grassroot Soccer, Kicking AIDS Out, MYSA, Parivartan• USAID, Nike, EJAF, MAC AIDS Fund, Comic Relief, Barclays
– Programs use sports themes, activities, role models
– Growing evidence base on effectiveness
Assessing the evidence of sport-based HIV prevention through a systematic review
Zachary A. Kaufman, MScPhD Candidate, LSHTM
Systematic review objectives
• To assess and synthesize the evidence
of effectiveness for SBHP interventions
• To identify gaps in existing research in
order to inform future studies
Methods• Inclusion criteria
– Assessing SBHP effectiveness quantitatively– Interventions using sport at least partially– Interventions aimed at preventing HIV– RCTs, quasi-experimental, pre/post, cross-sectional
• Study quality appraisal– Adapted Newcastle-Ottawa scale (NOS)
• Analysed evidence strength across outcomes– Knowledge, attitudes, communication, behaviour– Service uptake, biological outcomes (HIV, HSV, etc)– Sensitivity analysis: restricted to published studies
Included studies (n=21)Ref Authors Year Source Study Design N Country Age group Intervention Length K A C B S Bio
16 Clark et al. 2006 AIDS & BehaviorQuasi-
experimental304 Zimbabwe 12-14 years GRS
4 sessions 8 hours
24Peacock-Villada et al.
2007New Dir for Youth
DevelopmentPre/Post 274 Zambia 10-18 years GRS/Resiliency 6 weeks
23 Maro et al. 2009Scand J Med Sci
SportsQuasi-
experimental764 Tanzania 12-15 years EMIMA/KAO 8 weeks
25 Rhodes et al. 2009AIDS Education and Prevention
Quasi-experimental
222 USAmean age: 29 years
HoMBReS 18 months
18 Fuller et al. 2010British Journal of Sports Medicine
Quasi-experimental
370 South Africa 11-15 yearsFootball-For-
Health11 sessions 16.5 hours
17 Delva et al. 2010 AIDS Care Cross-sectional 892 Kenya 12-24 years MYSA Varied
19 Fuller et al. 2011British Journal of Sports Medicine
Pre/Post 389 Mauritius 12-15 years 11 For Health11 sessions 16.5 hours
19 Fuller et al. 2011British Journal of Sports Medicine
Pre/Post 395 Zimbabwe 10-14 years 11 For Health11 sessions 16.5 hours
21 Kaufman et al. In press AIDS CareQuasi-
experimental140
Dominican Rep.
10-20 years GRS5 sessions 10 hours
29 Rajan et al. 2008136th APHA
Annual MeetingPre/Post 2,197 Ethiopia 13-24 years
Sport for Life^ Youth Action Kit^
24-30 activities
26 Gray et al. 2009IV SA AIDS Conference
Quasi-experimental
478 South Africa 13-18 yearsExtra Time Magazine^
Just magazine
20 Kaufman et al. 2010XVIII International AIDS Conference
Cross-sectional 246 Zimbabwe 15-19 years GRS 10 hours
20 Kaufman et al. 2010XVIII International AIDS Conference
Cross-sectional 307 Botswana 15-19 years GRS 10 hours
22 Kruse 2006 NORAD Cross-sectional 80 Zambia 14-18 years KAO Unclear
15 Mercy Corps 2007 mercycorps.org Pre/Post 280 Liberia 16-30 years Yes to Soccer^14 activities
6 weeks
15 Mercy Corps 2007 mercycorps.org Pre/Post 360Southern
Sudan14-25 years
Sports for Peace and Life^
15 activities 8 weeks
27 Wardell 2009 AuthorQuasi-
experimental94 St. Lucia 10-16 years
Football For Lives^
Unclear
30 Kim et al. 2010 Author Pre/Post 69 USA 10-15 years Grassroot Project^ 8 weeks
28 Luppe 2010 Author Pre/Post 61 South Africa 9-20 years GRS8 sessions 4 weeks
31Braunschweig et al.
2011 Author Pre/Post 612 South Africa 14-17 years Generation Skillz^ 11 sessions
^ Intervention adapted from GRS curriculum Outcome reportedly assessed in this study
*K=Knowledge; A=Reported attitudes; C=Reported communication; B=Reported behaviours; S=Service uptake; Bio=Biomarkers
Gre
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Outcomes Assessed*Intervention DetailsStudy Details
No randomised controlled trials.
No studies with biomarkers.
Figure 2: SBHP effects on knowledge
Figure 3: SBHP effects on communication
Conclusions on effectiveness of SBHP
• Overall strong evidence of effect on:– HIV-related knowledge– HIV-related communication
• Overall weak evidence of effect on:– HIV-related attitudes– Reported sexual behaviour
• Generally low-quality studies to date– Need stronger methodology
Conclusions: gaps in research
• Need stronger methodology– Randomisation: in sampling and allocation– Longer-term follow-up– More objective, rigorous outcomes
• Effects on service uptake?– Does SBHP increase HCT uptake?– Can SBHP increase MMC uptake?
• Effects on biological outcomes?– Does SBHP reduce HIV, STI incidence?
Questions and Discussion