Impact of layered behavioral, socio-economic and school-based interventions on selected behavioral and biomarker indicators among adolescent girls and young women in Uganda

Globally, adolescent girls and young women (AGYW) continue to be at an elevated risk of HIV infection. We assessed the impact of layered behavioral, socio-economic and school-based interventions on selected behavioral and biomarker indicators among AGYW in Uganda. We used data from two serial cross-sectional surveys conducted in 14 (eight intervention and six comparison) districts in 2018 (n = 8,236) and 2023 (n = 5,449). Between 2019 and 2023, AGYW in the intervention districts received social and behavioral change communication plus either socio-economic support, vocational skills-based training or educational subsidies, as appropriate. AGYW in the comparison districts were not exposed to these interventions. We collected data on eight behavioral and two biomarker (HIV, syphilis) indicators. Exposure to AGYW interventions was defined as participation in or receipt of at least one intervention and expressed as a percentage. Impact was determined using a difference-in-difference approach with the observed net effect assumed to represent the overall impact of the interventions. We compared the effect of the interventions between exposed and unexposed AGYW and between intervention and non-intervention districts or schools. Data were analyzed using STATA, version 16.0. Half of the AGYW were in school while 50-70% were single/never married. Overall exposure to AGYW interventions was low; ranging from 4.4% to 43% depending on the type of intervention. Exposure to the interventions had a small net effect (0.7% to 14%) on almost all behavioral indicators and HIV prevalence was much higher among exposed than unexposed AGYW (1.56% vs. 0.94%). Syphilis prevalence was much lower among exposed than unexposed AGYW (0.26% vs. 0.82%) with an overall marginal net decline of 1.0% in the intervention versus non-intervention districts or schools. These findings suggest a need for a critical re-appraisal of the design and implementation of interventions targeting AGYW in order to achieve the desired changes in behavioral and biomarker indicators.