{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T22:50:05Z","timestamp":1787957405227,"version":"build-2784847793"},"update-to":[{"DOI":"10.12688\/gatesopenres.13636.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000}},{"DOI":"10.12688\/gatesopenres.13636.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000}}],"reference-count":60,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["INV-007156"],"award-info":[{"award-number":["INV-007156"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["gatesopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Gates Open Res"],"abstract":"<ns4:p>Background South African adolescents experience barriers to sexual and reproductive health (SRH) knowledge and uptake. This study provides insight into contraceptive and other SRH service knowledge, perceptions, and uptake among adolescents in high HIV prevalence settings. Methods A baseline cross sectional survey was conducted among 3432 grade 8s enrolled into the Girls Achieve Power (GAP Year) trial from 26 public high schools across three South African townships (Soweto, Thembisa and Khayelitsha) (2017 - 2018). An interviewer-led survey collected information on SRH knowledge and perceptions; an audio computer-assisted self-interviewing technique gathered SRH service uptake. Descriptive analysis indicates frequency distribution of socio-demographics and knowledge, uptake and perceptions of SRH services. Chi-square test tested for associations between age and sex and selected variables that measure SRH knowledge and uptake. Results In total, 2383 participants completed both survey components. Of these, 63.1% (n=1504) were female and 81.4% (n=1938) aged 12-14. Almost a fifth (18.3%, n=436) had ever had sex and less than 1% had accessed SRH services in the last year. Of the 157 females who had ever had sex, 50.9% had ever used contraception. Of those who had sex in the last three months, 59.0% reported using a contraceptive method. Condom use was inconsistent: almost all females said they had not used or could not remember if a condom was used at last sex. Conclusion This paper contributes to the evidence strengthening learner SRH education, including the national Integrated School Health Programme. Key themes include the need for age-appropriate, differentiated comprehensive sexuality education (CSE) for the range of ages found in the same grade in South African schools. Education on different contraceptive methods, informed decision-making, and emergency contraception is key. School-based interventions should embrace integrated HIV, STI, and pregnancy prevention messages. Closer links with health services need to be constantly fostered and reinforced.<\/ns4:p>","DOI":"10.12688\/gatesopenres.13636.3","type":"journal-article","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T10:55:07Z","timestamp":1731322507000},"page":"67","update-policy":"https:\/\/doi.org\/10.12688\/gatesopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Knowledge and uptake of contraceptive and other sexual reproductive health services among in-school adolescents in three South African townships: Baseline findings from the Girls Achieve Power (GAP Year) Trial"],"prefix":"10.12688","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1323-6162","authenticated-orcid":false,"given":"Melanie","family":"Pleaner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5545-7030","authenticated-orcid":false,"given":"Alison","family":"Kutywayo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mags","family":"Beksinska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khuthala","family":"Mabetha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7197-9426","authenticated-orcid":false,"given":"Nicolette","family":"Naidoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7039-1949","authenticated-orcid":false,"given":"Saiqa","family":"Mullick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2024,11,11]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"S1-s2","DOI":"10.1016\/j.jadohealth.2019.09.010","article-title":"Adolescents' sexual and reproductive health and rights: what has been achieved in the 25 years since the 1994 International Conference on Population and Development and what remains to be done?","volume":"65","author":"C Kabiru","year":"2019","journal-title":"J Adolesc Health."},{"key":"ref-2","doi-asserted-by":"publisher","DOI":"10.1080\/26410397.2020.1741495","article-title":"Progress in adolescent sexual and reproductive health and rights globally between 1990 and 2016: what progress has been made, what contributed to this, and what are the implications for the future?","volume":"28","author":"V Chandra-Mouli","year":"2020","journal-title":"Sex Reprod Health Matters."},{"key":"ref-3","article-title":"From bad to worse: the COVID-19 pandemic risks further undermining adolescents\u2019 sexual and reproductive health and rights.","year":"2020"},{"key":"ref-4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2019-002231","article-title":"Adolescent sexual and reproductive health in sub-Saharan Africa: who is left behind?","volume":"5","author":"D Melesse","year":"2020","journal-title":"BMJ Glob Health."},{"key":"ref-5","article-title":"Women and HIV: a spotlight on adolescent girls and young women","year":"2019"},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"2642-2692","DOI":"10.1016\/S0140-6736(18)30293-9","article-title":"Accelerate progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission.","volume":"391","author":"A Starrs","year":"2018","journal-title":"Lancet."},{"key":"ref-7","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-021-01145-4","article-title":"Adolescent sexual and reproductive health for all in sub-Saharan Africa: a spotlight on inequalities.","volume":"18","author":"V Chandra-Mouli","year":"2021","journal-title":"Reprod Health."},{"key":"ref-8","article-title":"Integrated School Health Policy.","year":"2012"},{"key":"ref-9","article-title":"Standard Operating Procedures for the provision sexual and reproductive health and social services in secondary schools.","year":"2019"},{"key":"ref-10","article-title":"National integrated Sexual Reproductive Health and Rights (SRHR) policy","year":"2019"},{"key":"ref-11","article-title":"South Africa Demographic and Health Survey 2016.","year":"2019"},{"key":"ref-12","article-title":"South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017: towards achieving the UNAIDS 90-90-90 targets.","author":"L Simbayi","year":"2019"},{"key":"ref-13","first-page":"43-47","article-title":"Contraceptive use and associated factors among South African youth (18 - 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Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v3\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v3\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v3\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T10:55:10Z","timestamp":1731322510000},"score":1,"resource":{"primary":{"URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,11]]},"references-count":60,"URL":"https:\/\/doi.org\/10.12688\/gatesopenres.13636.3","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/gatesopenres.13636.2","asserted-by":"subject"},{"id-type":"doi","id":"10.12688\/gatesopenres.13636.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.21956\/gatesopenres.16764.r38445","asserted-by":"object"}]},"ISSN":["2572-4754"],"issn-type":[{"value":"2572-4754","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,11]]},"assertion":[{"value":"Indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v3#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/gatesopenres.14915.r32124, Belete Yimer, Department of Human Nutrition, Debre Markos University, Debre Markos, 08 Jun 2022, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v1#referee-response-32124","order":0,"name":"referee-response-32124","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Alison Kutywayo<\/b>; \n<i>Posted: 01 Jul 2022<\/i>; The title should be modified as: &quot;Contraceptive knowledge and uptake among school adolescents in three South African townships...&quot;, in order to better convey the key features of the article.  \n<b>Response<\/b>: The title has been amended as suggested.  The authors used Chi-squared statistic tests for proportion comparison.&nbsp;To identify predictors of interest of knowledge, uptake and perceptions around SRH controlling for the confounding effects, multiple regression could be usedThe authors used Chi-squared statistic tests for proportion comparison.&nbsp;To identify predictors of interest of knowledge, uptake and perceptions around SRH controlling for the confounding effects, multiple regression could be used  \n<b>Response:&nbsp;<\/b>The data presented is from the baseline- prior to any intervention. We were not expecting high levels of service uptake in this group of grade 8 learners. Grade 8 learners are usually aged 12-14 years but there were a significant proportion who were older (15-18) and these young people would have had to repeat school years due to exam failure or other social\/financial\/health reasons for school exclusion. In terms of their maturity, sexual experience and social circumstances they are a very different group and so we tried to focus on these as two separate and distinct age groups and not compare them too closely at baseline due to their different circumstances. In the 12 -14 age group although table 2 shows 10% of females had ever had sex - a much lower proportion had experienced sexual debut in the 12-14 age compared to the 15-18 year olds as expected. SRH service uptake was also extremely low in both age groups and in males and females which we expected at this age as few were sexually experienced. Only 11 girls aged 12-14 of 1504 had accessed HIV testing services for instance. Because of this low uptake, we felt that a descriptive analysis would be easier to present as numbers were too low for any meaningful multiple regression or other more complex analysis.  The recommendations need to be based on the findings of the study in question and not general observations and dissemination of knowledge. I suggest the authors to narrow down their recommendations and focus on what they found alone.  \n<b>Response<\/b>:&nbsp;In addressing this comment, we have removed the general observations in the Discussion and Conclusion to ensure it is inline with our findings.","URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v3#referee-comment-3548","order":1,"name":"referee-comment-3548","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.14980.r32262, Catherine MacPhail, School of Health and Society, University of Wollongong, Wollongong, NSW, 19 Jul 2022, version 2, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v2#referee-response-32262","order":2,"name":"referee-response-32262","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.14980.r33160, Julie Hernandez, Department of Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, 25 May 2023, version 2, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v2#referee-response-33160","order":3,"name":"referee-response-33160","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Alison Kutywayo<\/b>; \n<i>Posted: 25 Jan 2024<\/i>; Thank you to the reviewer for this thoughtful and thorough review of our manuscript.&nbsp;There were a number of comments which have been addressed in the following ways:&nbsp; - The use of the term ''SRH and HIV'':&nbsp;In South Africa, and sub-Saharan Africa, the term SRH and HIV is commonly used as a package of distinct but interrelated interventions be it prevention, treatment, health promotion, advocacy etc. While there is an intersection, the two have separate policies and programmes in South Africa, and therefore we tend to refer to SRH and HIV. The introduction provides detail of the scope in this context. - Regarding the definition of knowledge:&nbsp;We wanted to probe their knowledge and uptake about SRH services broadly; and their utilisation and experience thereof. It was beyond the scope to probe detailed knowledge about each method. &nbsp;Sentence added to Introduction to clarify terminology and use of the word \u2018\u2019knowledge\u2019\u2019. - Based on reviewer feedback, the following limitations have been added: limited generalizability due to small school sample, refusal rate not collected leading to possible participation bias and some significant differences presented in the results may be attributed to under-reporting and AGYW targeting.&nbsp; - Power to run the study:&nbsp;Prior to commencing with our analysis, we set the statistical power to 0.8 (can also be specified as 80%) with an effect size of 5% and an alpha of 0.05 and this is usually considered to be the ideal power of a study. This was done with the purpose of lowering the risk of making a Type II error and thus given this instance, it was important to rather lean towards a Type I error which was as low as 0.05 or 0.01. We do however acknowledge that the sample size of young women who have ever had sex (n=157) was not sufficient enough to conduct inferential statistics with which affects the ability to comment on any significant differences between the two age groups. The n presented is lower (n=80) as it includes only information on the contraceptive users. We have therefore removed the P values which were non-significant and mentioned the descriptive presentation when the table is introduced. - Minor edits to the text have been amended, as per the reviewers suggestions.&nbsp; - Table 3: uptake of contraception methods is presented in Table 3. - Discussion: the Discussion has been edited and streamlined extensively aligning to the key findings, as suggested by the reviewer. - Discussion and Conclusion has been reviewed to ensure recommendations acknowledge the resource constrained context within which this research was conducted.&nbsp; - References made to the GAP Year intervention have been removed in the Discussion.&nbsp; -&nbsp; Throughout the manuscript we now talk about ''participants'', not learners.&nbsp;  Please see the updated version of the manuscript for your review.","URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v3#referee-comment-3667","order":4,"name":"referee-comment-3667","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.14980.r33165, Megan A Cohen, Emory University, Atlanta, Georgia, 30 May 2023, version 2, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v2#referee-response-33165","order":5,"name":"referee-response-33165","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Alison Kutywayo<\/b>; \n<i>Posted: 25 Jan 2024<\/i>; Thank you for your extensive review of our manuscript. We welcome this feedback for strengthening the paper and have addressed the comments as follows:&nbsp; \n<b>General comments:&nbsp;<\/b>  Sentence added to Introduction to clarify terminology and use of the word \u2018\u2019knowledge\u2019\u2019.  \n<b>Methods:&nbsp;<\/b>  A previous reviewer asked for more information on the GAP Year program however we have edited this section to streamline it further. The outcomes of the study were all powered for using a power of 0.8. However, given that there were small sample sizes in some of the variables, this is the reason why a number of variables were non-significant. An explanation of how the sample size was derived was provided on page 5. We have however indicated that it represents the actual sample of the trial.&nbsp;  \n<b>Results:&nbsp;<\/b>  The discrepancies in the data reported in the tables have been amended. Footnotes have been added to Table 2 to provide the reader clarity. We have removed p-values from Table 3 given the small sample size and non-significant differences.  \n<b>Discussion:&nbsp;<\/b>  The Discussion has been streamlined and revised in line with the key findings. The Limitations have been amended, in line with the reviewers comments.&nbsp;","URL":"https:\/\/gatesopenresearch.org\/articles\/6-67\/v3#referee-comment-3668","order":6,"name":"referee-comment-3668","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported, in whole by the Bill & Melinda Gates Foundation [INV-007156]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":7,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}