Changes in HIV risk behaviours and their correlates among adolescents in post-conflict settings following multifaceted health education: a quasi-experimental study in Nimule, a peri-urban town of South Sudan

As countries make progress in ending AIDS by 2030, gains made are being reversed due to an increase in new HIV infections, particularly among vulnerable adolescents in post-conflict settings where access to information remains limited. This study aimed to assess self-reported HIV risk factors and their correlates among adolescents before and after completing a multifaceted health education programme in the peri-urban town of Nimule, South Sudan. We designed a quasi-experimental quantitative study and recruited adolescents aged 10–17 years into 40 health clubs, where they received comprehensive health education delivered over a period of four months. Participants were then followed up for an additional 24 months. Using a semi-structured adolescent survey questionnaire, we collected baseline (December 2020) and endline (December 2022) data on five self-reported HIV risk factors. Using Stata version 16, we compared baseline vs. endline data using paired tests. We fitted multivariable logistic regression models to estimate adjusted odds ratios for key outcomes, adjusting for socio-demographic covariates. Adjusted odds ratios (AORs) corresponding to p < 0.05 at 95% confidence intervals were used to report any significant associations. Out of the estimated population of 652 adolescents, 557 (85.5%) were retained at endline; 301 (54.0%) were female, and 256 (46.0%) were male. The median age was 14 years (IQR: 11–16) at baseline and 15 years (IQR: 12–17) at endline. At both baseline and endline, 539 (96.8%) reported that they had not experienced any signs and symptoms of sexually transmitted infections. Over 90% at both baseline and endline reported that they had not slept outside their home in the past week and had not been touched in their genitals by someone of their opposite sex. The proportion who self-reported that they had never had sex in the past 30 days reduced from 89 (16.0%) at baseline to 88 (15.8%) at endline. Of those who reported having had sex, 58 (64.4%) used a condom in their last sex at baseline and 70 (78.6%) at the endline. About 86% reported not having taken alcohol, and over 90% reported not having smoked. Compared with the baseline survey, the odds of reporting at least one HIV risk factor were 23% lower at the endline survey (aOR 0.77, 95% CI: 0.73–0.80, p < 0.001). Equally, higher odds of self-reported risks were observed among male adolescents (aOR 1.11, 95% CI: 1.06–1.15, p < 0.001), those in the age range 15–17 years (aOR 1.27, 95% CI: 1.21–1.34, p < 0.001) and those cared for by non-parents (aOR 1.29, 95% CI: 1.21–1.36, p < 0.001). A multifaceted health education delivered by trained peer educators was associated with a significant reduction in HIV risk factors among adolescents at the endline compared to the baseline survey, where gender (male), age (15–17), and living under the care of a non-parent were the correlates of higher risks reported. These findings underscore important programmatic, policy and future research implications for integrated health education as a facilitator of HIV risk reduction among adolescents in resource-limited post-conflict settings.