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APHA Scientific Session and Event Listing

Recorded presentation

Timothy Williams, MA, MEM¹, Ugochi Daniels², Stephanie A. Mullen, DrPH¹, Michael J. McQuestion, MS, MPH, PhD³, Ali Karim, PhD¹, Disha Ali⁴, and Jessica Posner, MPH¹. (1) John Snow, Inc., 1616 North Fort Myer Drive, 11th Floor, Arlington, VA 22209, 7035287474, tim_williams@jsi.com, (2) UNFPA, 220 East 42nd Street, New York, NY 10017, (3) Department of Population & Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, (4) International Health and Development, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112

The Africa Youth Alliance (AYA), a Gates-funded partnership between PATH, Pathfinder International, and UNFPA, worked in four African countries from 2000-05 to improve adolescent sexual and reproductive health (ASRH) through integrated, comprehensive, multi-sectoral, and scaled up programs. The comprehensive approach was based on fostering a supportive environment for ASRH through appropriate policy and advocacy; developing effective behavior change communication for ASRH; integrating ASRH into existing livelihood skills development programs for youth (in-school and out-of-school); and expanding access to youth friendly services. The approach was unique in seeking to implement all components simultaneously, while building capacity and fostering coordination among established partners to encourage sustainability of ASRH services.

As part of a broader evaluation of AYA, a population-based survey was carried out among youth aged 17-22 in Ghana, Tanzania, and Uganda to evaluate the impact of AYA interventions on ASRH in those countries. The post-test only research design will determine program impact by comparing behavioral outcomes 1) between intervention sites and controls, and 2) between youth who were exposed to AYA programs by varying degrees and those who were not. A combination of propensity score matching and instrumental variable approaches will be used to analyze results. Two-stage cluster sampling was employed to survey 1,800-3,400 youths, depending on the country.

This presentation will review principal findings from surveys in the three countries, focusing on AYA's impact on four key behavioral outcomes, as well as the effect of interventions on antecedents such as ASRH knowledge and attitudes. The key behavioral outcomes that AYA attempted to influence and that will be addressed in the presentation included: condom use, age of sexual debut, number of sexual partners, and use of contraceptives. Key outcome and antecedent indicators will be presented for AYA intervention sites and controls, and for youth exposed to AYA to varying degrees vs. youth who were not exposed or exposed to non-AYA interventions. Findings from the surveys will provide valuable insights on keys to success in ASRH programs for decision makers in AYA countries and in other African settings more broadly.

Learning Objectives: By the end of the session participants will be able to

• cite key results from the impact evaluation on RH knowledge, attitudes, and outcomes among young people in the three AYA countries
• describe how propensity score matching and instrumental variable analysis were used to enable impact measurement in a post-test only research design
• articulate how the study findings can be used by decision makers to improve youth program effectiveness and outcomes

Keywords: Adolescents, International, Reproductive Health Research

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation