{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T05:52:02Z","timestamp":1775109122829,"version":"3.50.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T00:00:00Z","timestamp":1602633600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T00:00:00Z","timestamp":1602633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID-OAA-L-14-00004"],"award-info":[{"award-number":["AID-OAA-L-14-00004"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Young people under age 25\u2009years are a key population at risk of unintended pregnancies, HIV and other sexually transmitted infections. School-based programming, focusing on youth under 17\u2009years is strategic given that many in this age group are in school or are required to be in school and spend a considerable amount of their time at school. Prior evaluations of school-based HIV prevention programs for young people often employed weak study designs or lacked biomarkers (e.g., HIV or STI testing) to inform outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This study used longitudinal data collected in 2016 from a cohort of grade-8 girls from Mpumalanga and KwaZulu-Natal Provinces in South Africa. We followed them for 2 years to examine the impact of the South African Department of Basic Education\u2019s revised scripted lesson plans for the HIV and sexual content of a \u201clife orientation\u201d curriculum on knowledge, attitudes, condom use behaviors, pregnancy incidence, and genital herpes incidence. Schools were randomized to intervention and control arms. Multivariable analyses were undertaken using hazard modeling for incidence-based outcomes (genital herpes and pregnancy) and generalized linear latent and mixed modeling for outcomes measured at each time period (knowledge, attitudes, and condom use).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>At end line, 105 schools were included from the two provinces (44 from Mpumalanga and 61 from KwaZulu-Natal). Fifty-five were intervention and fifty were control schools. A total of 2802 girls were surveyed at both time periods (1477 intervention and 1325 control). At baseline, participating girls were about 13.6\u2009years; by end line, they were about 2 years older. Longitudinal data demonstrated few differences between intervention and control groups on knowledge, attitudes, condom use, genital herpes, and pregnancy experience. Monitoring data demonstrated that the program was not implemented as intended. Our results demonstrated 7% incidence of genital herpes in the two-year follow-up period indicating sexual risk-taking among our cohort.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We did not find significant effects of the revised life orientation curriculum on key outcomes; however, this may reflect poor implementation. Future HIV prevention programs for young people need to be implemented with fidelity to ensure they meet the crucial needs of the next generation.<\/jats:p>\n                <jats:p>Trial Registration: This study has been registered at <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>. The trial registration number is: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04205721?term=NCT04205721&amp;draw=2&amp;rank=1\">NCT04205721<\/jats:ext-link>. The trial was retrospectively registered on December 18, 2019.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12889-020-09640-2","type":"journal-article","created":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T09:03:43Z","timestamp":1602666223000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Impact evaluation of scripted lesson plans for HIV-related content in a life orientation curriculum: results from two provinces in South Africa"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6204-1316","authenticated-orcid":false,"given":"Ilene S.","family":"Speizer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahua","family":"Mandal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khou","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ndinda","family":"Makina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aiko","family":"Hattori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darryn","family":"Durno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,10,14]]},"reference":[{"key":"9640_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1742-4755-11-1","volume":"11","author":"V Chandra-Mouli","year":"2014","unstructured":"Chandra-Mouli V, McCarraher DR, Phillips SJ, Williamson NE, Hainsworth G. Contraception for adolescents in low and middle income countries: needs, barriers, and access. Reprod Health. 2014;11:1 Available at: http:\/\/www.reproductive-health-journal.com\/content\/11\/1\/1.","journal-title":"Reprod Health"},{"issue":"1","key":"9640_CR2","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s12978-017-0347-9","volume":"14","author":"V Chandra-Mouli","year":"2017","unstructured":"Chandra-Mouli V, Parameshwar PS, Parry M, et al. A never-before opportunity to strengthen investment and action on adolescent contraception and what we must do to make full use of it. Reprod Health. 2017;14(1):85. https:\/\/doi.org\/10.1186\/s12978-017-0347-9.","journal-title":"Reprod Health"},{"key":"9640_CR3","volume-title":"UNAIDS data 2019","author":"UNAIDS","year":"2019","unstructured":"UNAIDS. UNAIDS data 2019. 2019. Available at: https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/2019-UNAIDS-data_en.pdf."},{"issue":"2","key":"9640_CR4","doi-asserted-by":"publisher","first-page":"e1002511","DOI":"10.1371\/journal.pmed.1002511","volume":"15","author":"EA Torrone","year":"2018","unstructured":"Torrone EA, Morrison CS, Chen P-L, et al. Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: an individual participant data meta-analysis of 18 HIV prevention studies. PLoS Med. 2018;15(2):e1002511 Available at: https:\/\/doi.org\/10.1371\/journal. pmed.1002511.","journal-title":"PLoS Med"},{"issue":"8","key":"9640_CR5","doi-asserted-by":"publisher","first-page":"e0220970","DOI":"10.1371\/journal.pone.0220970","volume":"14","author":"EK Ameyaw","year":"2019","unstructured":"Ameyaw EK, Budu E, Sambah F, et al. Prevalence and determinants of unintended pregnancy in sub Saharan Africa: a multi-country analysis of demographic and health surveys. PLoS One. 2019;14(8):e0220970 Available at: https:\/\/doi.org\/10.1371\/journal. pone.0220970.","journal-title":"PLoS One"},{"key":"9640_CR6","doi-asserted-by":"publisher","first-page":"e1521","DOI":"10.1016\/S2214-109X(19)30410-3","volume":"7","author":"I Birdthistle","year":"2019","unstructured":"Birdthistle I, Tanton C, Tomita A, et al. Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis. Lancet Glob Health. 2019;7:e1521\u201340. https:\/\/doi.org\/10.1016\/S2214-109X(19)30410-3.","journal-title":"Lancet Glob Health"},{"key":"9640_CR7","volume-title":"South Africa Demographic and Health Survey 2016","author":"National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), and ICF","year":"2019","unstructured":"National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), and ICF. South Africa Demographic and Health Survey 2016. Pretoria, South Africa, and Rockville, Maryland, USA: NDoH, Stats SA, SAMRC, and ICF; 2019."},{"key":"9640_CR8","volume-title":"The fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017: HIV impact assessment summary report","author":"Human Sciences Research Council (HSRC)","year":"2018","unstructured":"Human Sciences Research Council (HSRC). The fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017: HIV impact assessment summary report. Cape Town: HSRC Press; 2018."},{"issue":"2","key":"9640_CR9","doi-asserted-by":"publisher","first-page":"e1002512","DOI":"10.1371\/journal.pmed.1002512","volume":"15","author":"SC Francis","year":"2018","unstructured":"Francis SC, Mthiyane TN, Baisley K, et al. Prevalence of sexually transmitted infections among young people in South Africa: a nested survey in a health and demographic surveillance site. PLoS Med. 2018;15(2):e1002512 Available at: https:\/\/doi.org\/10.1371\/journal.pmed.1002512.","journal-title":"PLoS Med"},{"issue":"4","key":"9640_CR10","doi-asserted-by":"publisher","first-page":"307","DOI":"10.7196\/SAMJ.2017.v107i4.12141","volume":"107","author":"MF Chersich","year":"2017","unstructured":"Chersich MF, Wabiri N, Risher K, et al. Contraception coverage and methods used among women in South Africa: a national household survey. S Afr Med J. 2017;107(4):307\u201314. https:\/\/doi.org\/10.7196\/SAMJ.2017.v107i4.12141.","journal-title":"S Afr Med J"},{"key":"9640_CR11","volume-title":"WHO Guidelines for preventing early pregnancy and poor reproductive outcomes in adolescents in developing countries","author":"WHO","year":"2011","unstructured":"WHO. WHO Guidelines for preventing early pregnancy and poor reproductive outcomes in adolescents in developing countries. Geneva: WHO; 2011."},{"issue":"5","key":"9640_CR12","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1016\/S1054-139X(02)00535-9","volume":"33","author":"IS Speizer","year":"2003","unstructured":"Speizer IS, Magnani RJ, Colvin CE. The effectiveness of adolescent reproductive health interventions in developing countries: a review of the evidence. J Adolesc Health. 2003;33(5):324\u201348. https:\/\/doi.org\/10.1016\/S1054-139X(02)00535-9.","journal-title":"J Adolesc Health"},{"key":"9640_CR13","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1007\/s11121-017-0861-6","volume":"19","author":"E Marseille","year":"2018","unstructured":"Marseille E, Mirzazadeh A, Biggs MA, et al. Effectiveness of school-based teen pregnancy prevention programs in the USA: a systematic review and meta-analysis. Prev Sci. 2018;19:468\u201389 Avalable at: https:\/\/doi.org\/10.1007\/s11121-017-0861-6.","journal-title":"Prev Sci"},{"key":"9640_CR14","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1007\/s11121-017-0830-0","volume":"19","author":"A Mirzazadeh","year":"2018","unstructured":"Mirzazadeh A, Biggs MA, Viitanen A, et al. Do school-based programs prevent HIV and other sexually transmitted infections in adolescents? A systematic review and meta-analysis. Prev Sci. 2018;19:490\u2013506. https:\/\/doi.org\/10.1007\/s11121-017-0830-0.","journal-title":"Prev Sci"},{"issue":"3","key":"9640_CR15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0089692","volume":"9","author":"VA Fonner","year":"2014","unstructured":"Fonner VA, Armstrong KS, Kennedy CE, O\u2019Reilly KR, Sweat MD. School based sex education and HIV prevention in low- and middle-income countries: a systematic review and meta-analysis. PLoS One. 2014;9(3):e89692. https:\/\/doi.org\/10.1371\/journal.pone.0089692.","journal-title":"PLoS One"},{"key":"9640_CR16","doi-asserted-by":"publisher","unstructured":"Mason-Jones AJ, Sinclair D, Mathews C, Kagee A, Hillman A, Lombard C. School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents. Cochrane Database Syst Rev. 2016;(11):CD006417. https:\/\/doi.org\/10.1002\/14651858.CD006417.pub3.","DOI":"10.1002\/14651858.CD006417.pub3"},{"issue":"1","key":"9640_CR17","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1080\/17290376.2017.1376704","volume":"14","author":"M Visser","year":"2017","unstructured":"Visser M. Rethinking HIV-prevention for school-going young people based on current behavior patterns. SAHARA J. 2017;14(1):63\u201375.","journal-title":"SAHARA J"},{"issue":"2","key":"9640_CR18","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1521\/aeap.2018.30.2.152","volume":"30","author":"IS Speizer","year":"2018","unstructured":"Speizer IS, Mandal M, Xiong K, et al. Methodology and baseline results from the evaluation of a sexuality education activity in Mpumalanga and KwaZulu-Natal, South Africa. AIDS Educ Prev. 2018;30(2):152\u201368.","journal-title":"AIDS Educ Prev"},{"key":"9640_CR19","volume-title":"Integrated strategy on HIV and AIDS 2012\u20132016, full report","author":"Department of Basic Education","year":"2010","unstructured":"Department of Basic Education. Integrated strategy on HIV and AIDS 2012\u20132016, full report. Pretoria, South Africa: Department of Basic Education; 2010. Available at: https:\/\/www.gov.za\/sites\/default\/files\/gcis_document\/201409\/integrated-strategy-hiv-aids.pdf."},{"key":"9640_CR20","volume-title":"Impact Evaluation of a School-Based Sexuality and HIV Prevention Education Activity in South Africa: Final Report","author":"K Xiong","year":"2019","unstructured":"Xiong K, Mandal M, Makina N, et al. Impact Evaluation of a School-Based Sexuality and HIV Prevention Education Activity in South Africa: Final Report. Chapel Hill, NC, USA: MEASURE Evaluation, University of North Carolina; 2019."},{"key":"9640_CR21","doi-asserted-by":"crossref","unstructured":"Speizer IS, Xiong K, Mandal M, et al. HIV-related knowledge, attitudes, and behaviors among grade 10 girls and boys in Mpumalanga and KwaZulu-Natal: cross-sectional results. Open AIDS J. 2020. https:\/\/benthamopen.com\/ABSTRACT\/TOAIDJ-14-75.","DOI":"10.2174\/1874613602014010075"},{"issue":"1","key":"9640_CR22","first-page":"1","volume":"10","author":"L Kish","year":"1965","unstructured":"Kish L. Survey sampling. Biom J. 1965;10(1):1\u201395.","journal-title":"Biom J"},{"key":"9640_CR23","unstructured":"Permission from Audrey Pettifor to use or adapt HTPN 068 survey tools, December 10, 2015. https:\/\/www.hptn.org\/research\/studies\/hptn068. Accessed 7 Oct 2020."},{"key":"9640_CR24","volume-title":"Working Report Measuring HIV Stigma: Results of a Field Test in Tanzania. 2005","author":"L Nyblade","year":"2005","unstructured":"Nyblade L, MacQuarrie M, Phillip F, et al. Working Report Measuring HIV Stigma: Results of a Field Test in Tanzania. 2005. Silver Spring, MD, USA: The Synergy Project, Social & Scientific Systems, Inc; 2005."},{"key":"9640_CR25","unstructured":"Permission from Gavin George to use HEARD tools used in South Africa school-based surveys, November 20, 2015."},{"issue":"3","key":"9640_CR26","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1177\/1097184X06298778","volume":"10","author":"J Pulerwitz","year":"2008","unstructured":"Pulerwitz J, Barker J. Measuring attitudes toward gender norms among young men in Brazil. Men Masculinities. 2008;10(3):322\u201338.","journal-title":"Men Masculinities"},{"issue":"3","key":"9640_CR27","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1363\/44e6818","volume":"44","author":"AJ Peterson","year":"2018","unstructured":"Peterson AJ, Donze M, Allen E, Bonell C. Effects of interventions addressing school environments or educational assets on adolescent sexual health: systematic review and meta-analysis. Int Perspect Sex Reprod Health. 2018;44(3):111\u201331.","journal-title":"Int Perspect Sex Reprod Health"},{"key":"9640_CR28","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1136\/sextrans-2014-051548","volume":"90","author":"Q Abdool Karim","year":"2014","unstructured":"Abdool Karim Q, Kharsany ABM, Leask K, et al. Prevalence of HIV, HSV-2, and pregnancy among high school learners in rural KwaZulu-Natal, South Africa: a bio-behavioural crosssectional survey. Sex Transm Infect. 2014;90:620\u20136.","journal-title":"Sex Transm Infect"},{"issue":"8","key":"9640_CR29","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1136\/jech-2015-206744","volume":"70","author":"R Kidman","year":"2016","unstructured":"Kidman R, Anglewicz P. Are adolescent orphans more likely to be HIV-positive? A pooled data analyses across 19 countries in sub-Saharan Africa. J Epidemiol Community Health. 2016;70(8):791\u20137. https:\/\/doi.org\/10.1136\/jech-2015-206744.","journal-title":"J Epidemiol Community Health"},{"issue":"5","key":"9640_CR30","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1016\/j.jadohealth.2010.08.007","volume":"48","author":"H Cho","year":"2011","unstructured":"Cho H, Hallfors DD, Mbai II, et al. Keeping adolescent orphans in school to prevent human immunodeficiency virus infection: evidence from a randomized controlled trial in Kenya. J Adolesc Health. 2011;48(5):523\u20136. https:\/\/doi.org\/10.1016\/j.jadohealth.2010.08.007.","journal-title":"J Adolesc Health"},{"issue":"1","key":"9640_CR31","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1080\/17290376.2017.1379428","volume":"14","author":"M Pienaar","year":"2017","unstructured":"Pienaar M, van Rooyen FC, Walsh CM. Household food security and HIV status in rural and urban communities in the Free State province, South Africa. SAHARA J. 2017;14(1):118\u201331. https:\/\/doi.org\/10.1080\/17290376.2017.1379428.","journal-title":"SAHARA J"},{"issue":"12","key":"9640_CR32","doi-asserted-by":"publisher","first-page":"e978","DOI":"10.1016\/S2214-109X(16)30253-4","volume":"4","author":"A Pettifor","year":"2016","unstructured":"Pettifor A, MacPhail C, Hughes JP, et al. The effect of a conditional cash transfer on HIV incidence in young women in rural South Africa (HPTN 068): a phase 3, randomised controlled trial [published correction appears in lancet glob health. 2017 Feb;5(2):e146]. Lancet Glob Health. 2016;4(12):e978\u201388. https:\/\/doi.org\/10.1016\/S2214-109X(16)30253-4.","journal-title":"Lancet Glob Health"},{"issue":"15","key":"9640_CR33","doi-asserted-by":"publisher","first-page":"2127","DOI":"10.1097\/QAD.0000000000001584","volume":"31","author":"MCD Stoner","year":"2017","unstructured":"Stoner MCD, Pettifor A, Edwards JK, et al. The effect of school attendance and school dropout on incident HIV and HSV-2 among young women in rural South Africa enrolled in HPTN 068. AIDS. 2017;31(15):2127\u201334. https:\/\/doi.org\/10.1097\/QAD.0000000000001584.","journal-title":"AIDS."},{"key":"9640_CR34","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1007\/s11121-014-0486-y","volume":"16","author":"B Wang","year":"2015","unstructured":"Wang B, Deveaux L, Knowles V, et al. Fidelity of implementation of an evidence-based HIV prevention program among Bahamian sixth grade students. Prev Sci. 2015;16:110\u201321.","journal-title":"Prev Sci"},{"issue":"1","key":"9640_CR35","first-page":"43","volume":"24","author":"G George","year":"2018","unstructured":"George G, Tucker LA, Panday S, Khumalo F. Challenges facing life orientation educators in the delivery of sexuality education in south African schools. South Afr Rev Educ. 2018;24(1):43\u201357.","journal-title":"South Afr Rev Educ"},{"key":"9640_CR36","doi-asserted-by":"publisher","first-page":"S176","DOI":"10.1097\/QAI.0000000000000182","volume":"66","author":"K Hardee","year":"2014","unstructured":"Hardee K, Gay J, Croce-Galis M, Afari-Dwamena NA. What HIV programs work for adolescent girls. J Acquir Immune Defic Syndr. 2014;66:S176\u201385.","journal-title":"J Acquir Immune Defic Syndr"},{"key":"9640_CR37","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1007\/s11904-019-00431-y","volume":"16","author":"S Hosek","year":"2019","unstructured":"Hosek S, Pettifor A. HIV prevention interventions for adolescents. Current HIV\/AIDS Reports. 2019;16:120\u20138. https:\/\/doi.org\/10.1007\/s11904-019-00431-y.","journal-title":"Current HIV\/AIDS Reports"},{"issue":"5","key":"9640_CR38","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1016\/j.amepre.2018.06.010","volume":"55","author":"AW Brittain","year":"2018","unstructured":"Brittain AW, Loyola Briceno AC, Pazol K, et al. Youth-friendly family planning Services for Young People: a systematic review update. Am J Prev Med. 2018;55(5):725\u201335. https:\/\/doi.org\/10.1016\/j.amepre.2018.06.010.","journal-title":"Am J Prev Med"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-020-09640-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-020-09640-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-020-09640-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T23:35:51Z","timestamp":1634168151000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-020-09640-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,14]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["9640"],"URL":"https:\/\/doi.org\/10.1186\/s12889-020-09640-2","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,14]]},"assertion":[{"value":"18 December 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 October 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"At each round of data collection, all participating girls and boys under the age of 18\u2009years received written parental consent to be surveyed and each young person provided written assent. For the biomarkers, there was separate written parental consent and participant assent. The study protocol including the consent and assent procedures were approved by the University of Pretoria Faculty of Health Sciences Research Ethics Committee (Ref. No. 153\/2016) and the University of North Carolina at Chapel Hill Institutional Review Board (IRB Number 15\u20133217). Enterprises University of Pretoria (Pty) Ltd. collected baseline data; SADC Research Centre collected midline and end line data.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1542"}}