Cluster randomized controlled trial of SKILLZ Girl among adolescent girls in Zambia: Effects on sexual and reproductive empowerment

DETAILED SUMMARY

Importance

• Zambian adolescent girls and young women (AGYW) face significant challenges related to sexual and reproductive health including an increased prevalence of HIV in comparison to their male counterparts (5.9% v.s. 1.8%), the burden of managing unwanted pregnancies, and poor maternal and child health outcomes. SKILLZ Girl seeks to improve sexual and reproductive empowerment among AGYW.

Objective

• To evaluate the effect of the SKILLZ intervention on the sexual and reproductive empowerment of Zambian AGYW.

Study details

• • Study design: Cluster randomized controlled trial 

• Data collection tools: Self-administered baseline, midline and endline questionnaires (occurring 6 months and 12 months post-intervention) measuring sexual and reproductive health empowerment via 23 items (score range= 0-low empowerment to 92-high empowerment) 

• Participants: 2,153 Grade 11 Zambian AGYW (1,134 intervention; 1,019 control) (median age 17). 

• Implementation setting: 46 secondary schools across four districts of Lusaka, Zambia.

• Study period: March 2021 to January 2023 (22 months)

Intervention 

• SKILLZ Girl: Grassroot Soccer’s adolescent girl-specific program with four components: 

• • Twelve peer-led after-school sessions delivered by a trained adult female Coach;  
  • A “graduation” event with HIV testing and contraceptive services provided at a mobile clinic.
  • Optional “Teen Club” events for continued guided learning with a Coach.
  • Community-based HIV screening kit distribution by Coaches

Results

• 3,208 AGYW assessed for eligibility, 1,917 surveyed at baseline, 236 additional AGYW were recruited after baseline survey, bringing total enrollees to 2,153. 93% retention rate (n = 1,997) at endline survey distribution point.
• Results demonstrated a 6.21 point SRE score increase in intervention schools at midline compared to control schools (SE: 0.75, p < 0.001; 6.75% change); at endline, results demonstrated a 5.12 point increase in intervention schools (SE: 0.71, p < 0.001; 5.57% change). 
• Among sexually active AGYW, being in an intervention school was associated with a 7.78-point increase (SE: 1.17, p<0.001) from baseline to midline and a 4.64 increase from baseline to endline (SE=0.93, p<0.001). 

Conclusions and Implications

• The SKILLZ Girl intervention modestly impacted sexual and reproductive empowerment among Zambian adolescent girls and young women, with results magnified among sexually active AGYW.