Peer-led sexual and reproductive health education and risky sexual behavior among adolescent girls and young women in rural Uganda: A quasi-experimental pre-post study

Adolescent girls and young women face significant sexual and reproductive health (SRH) challenges. This study assessed the preliminary effectiveness of a community-based, peer-led SRH education intervention on risky sexual behaviors and comprehensive SRH knowledge among adolescent girls and young women aged 15–24 years in Moroto District, northeastern Uganda. From October 2024 to January 2025, we conducted a pre-post quasi-experiment study without a comparison group across six villages. Participants were selected through a multi-stage sampling approach and assessed at the baseline. They subsequently received the community-based peer-led SRH education intervention, with each participant serving as their own control in the absence of a comparison group. Risky sexual behavior was the primary outcome, and comprehensive SRH knowledge was the secondary outcome, both measured on a binary scale. The intervention effect was assessed using a generalized estimating equation with a Poisson distribution, log link function, and exchangeable correlation structure. We reported adjusted risk ratios (aRR) with 95% confidence intervals (CI). Of 389 participants who completed both the pre- and post-intervention evaluation, the mean ages were comparable (19.29 ± 2.94 years vs. 19.31 ± 2.91 years; p = 0.922, respectively). After the intervention, there was a significant decline in the proportion of participants who engaged in risky sexual behavior (57.1% before vs. 37.8% after, p < 0.001) and a significant improvement in comprehensive SRH knowledge (85.6% before vs. 99.5% after, p < 0.001). Findings revealed a 33% reduction in risky sexual behavior (aRR 0.67, 95% CI: 0.57-0.75) and a 16% improvement in comprehensive SRH knowledge (aRR 1.16, 95% CI: 1.12-1.20). Accordingly, the intervention reduced risky sexual behavior and improved comprehensive SRH knowledge. However, these findings should be considered preliminary, as robust studies are needed, including a need for nuanced strategies to address contextual factors that contribute to risky behavior despite improved comprehensive SRH knowledge. Trial registration number: PACTR202608716882566.