Mixed methods study of SKILLZ for HIV prevention among adolescents in Ethiopia

DETAILED SUMMARY

Importance

• Ethiopia experienced a rapid rise in HIV prevalence during the 1990s, prompting national prioritization of youth-focused HIV prevention. Sport-based HIV prevention approaches have demonstrated promise, so GRS aimed to explore the reach of Sport For Life and pathways for its national adoption.

Objective

• To evaluate whether Sport For Life improves HIV-related knowledge, communication, and attitudes among adolescents and to examine pathways to national adoption over a four-month intervention period in Ethiopian schools.

Study details

• Study design: Mixed methods study; no control group.
• Data collection tools: Attendance registers; pre- and post-questionnaires; focus group discussions (3 groups with SFL participants, teachers, and trainers); key informant interviews (3 interviews with partner organization staff).
• Participants: Mixed-gender adolescents with a median age of 15 years, SFL-trained teachers, SFL trainers, and partner organization staff.
• Implementation setting: Primary and secondary schools in Addis Ababa, Ethiopia (predominantly urban and peri-urban).
• Study period: Attendance data collected 2004–2014; pre- and post-questionnaires administered immediately before and after a four-month program.

Intervention

• Other – Sport For Life: A sport-based HIV prevention curriculum delivered through structured football activities and facilitated discussions.

Results

• Reach: Attendance data show approximately 701,705 Ethiopian students participated in Sport For Life between 2004 and 2014.
• Quantitative findings: Results demonstrate an overall increase in favorable responses from pre- to post-questionnaire among Ethiopian participants (rate ratio: 1.12). The largest improvement was observed in knowledge of khat as an HIV risk factor (rate ratio: 2.17). Results demonstrate increased communication about HIV with adults (rate ratio: 2.07) and friends (rate ratio: 1.81).
• Comparative findings: Pre/post changes among Ethiopian participants were comparable to those observed at Grassroot Soccer–managed sites in South Africa, with greater improvements in HIV-related communication and stigma reduction observed in Ethiopia.
• Quote: 
  • “We learn on SFL with games and physical activities and we will not get bored and forget the points.” (SFL participant)

Conclusions and implications

• Results demonstrate that Sport For Life improves HIV-related knowledge, communication, and attitudes among adolescents.
• Focus group discussions and interviews suggest that strategic partnerships, political alignment, and sustained training and monitoring were critical to national adoption.