Cluster randomized controlled trial of SKILLZ Girl among adolescent girls in South Africa

DETAILED SUMMARY

Importance

• Adolescent girls in South Africa experience high rates of unintended pregnancy and curable STIs and face barriers to SRH services. A school-based, girl-centred, sport-based curricula (SKILLZ) may address needs while strengthening national comprehensive sexuality education (CSE).

Objective

• To evaluate whether SKILLZ Girl + national CSE compared with national CSE alone improves biomedical and socio-behavioural sexual and reproductive health outcomes among female secondary-school learners in peri-urban secondary schools in Cape Town, South Africa over ~8 months.

Study details

• Study design: Cluster-randomized controlled trial (schools randomized);
• Data collection tools: Nurse-facilitated biomedical testing; paper self-administered socio-behaviour questionnaire; attendance registers; WhatsApp reminders; program monitoring/fidelity checks.
• Participants: Female learners, school grades 8–10 (approx. 13–17 years)
• Implementation setting: 2800 participants in secondary schools in a single health sub-district of Cape Town, South Africa (peri-urban)
• Study period: Baseline and about 8 months.

Intervention

• SKILLZ Girl: 10 manualized sessions using sport activities, 45–60 min weekly across two school terms (~6 months). Fidelity checks by a master coach. Delivered after-school (Cohort 1) or in-school/after-school per school choice (Cohort 2); Cohort 2 additionally used WhatsApp reminders. The control arm received standard national CSE only.

Results

• Sample: Total enrolled n = 2,791 (Cohort1 n=1,239; Cohort2 n=1,552).
• Retention: 73.6% attended both visits; 24.0% lost to follow-up due to ineligibility, transfers, withdrawal, death
• Low attendance overall: mean ~44.2% (Cohort 1) and ~47.2% (Cohort 2)
• Baseline results: High baseline STI prevalence= Intervention 24.3%, Control 19.6%. Low incidence of pregnancy and similar across arms.
• Follow-up results: No significant differences between arms overall. Intervention participants did not show an improvement in SRH outcomes, with HIV and pregnancy incidence remaining stable and STI prevalence remaining high and increasing in both control and intervention arms

Conclusions and implications

• SKILLZ, as implemented in this trial (with low overall attendance), did not significantly reduce STI, HIV or pregnancy outcomes compared with national CSE alone
• Implementation barriers (attendance, delivery timing) limited intervention exposure;
• Future approaches should consider in-school delivery, stronger strategies to improve attendance, and layering SKILLZ-style education with direct SRH service access