Evaluation of Our Family Our Future: A Randomized Clinical Trial of a Family Resilience Intervention to Prevent Adolescent HIV/STI Infection and Depression in South Africa

Adolescents account for the majority of new HIV infections in South Africa and those with depressive symptoms are at elevated risk. Engaging families in preventive efforts is vital, but no effective interventions in South Africa integrate a family-based approach to adolescent HIV/STI prevention and depression. We report on results from a randomized controlled trial (RCT) testing the efficacy of Our Family Our Future, a family resilience intervention designed to address adolescent risk for depression, HIV and STIs. 879 adolescents (ages 14-16) in a high HIV prevalence urban setting near Cape Town, South Africa participated in a 2-arm, parallel, single-blinded RCT. Adolescents (along with one adult family member) were randomized to Our Family Our Future or to a control group. This analysis evaluates the intervention's efficacy in reducing (1) depressive symptoms, (2) HIV/STI incidence, (3) sexual debut, rates of vaginal and anal sex, and condomless sex. Data were collected via smartphone at baseline, 6 and 12 months. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale; HIV was gathered through dried blood spot samples, STIs through urine samples; vaginal sexual debut, anal sexual debut, rates of vaginal and anal sex, and condomless sex was gathered through self-report. A post-hoc analysis examined the "dosage" effect of session attendance on outcomes. Of 879 adolescents, 444 were randomized to the control group and 435 to the intervention. Retention rates were 81-84% at 6 months and 90-98% at 12 months. Intervention participants completed 88-98% of their assigned sessions. Primary outcomes showed no significant differences in HIV/STI incidence or most sexual behaviors at 6 or 12 months, but vaginal sex prevalence was lower in the intervention group at 12 months (55% vs. 65%, p = 0.007). Condom use and sexual debut rates were similar between groups. Depression scores were higher in the intervention group at 6 months (p = 0.004) but not at 12 months. Session attendance had no significant impact on depression or sexual behavior outcomes. Our Family Our Future showed mixed efficacy. The intervention reduced the number of adolescents engaging in vaginal sex at 12 months but had no effect on delaying sexual debut, reducing unprotected sex, or HIV/STI acquisition. Depression scores did not differ between groups at 12 months. Despite these mixed results, the reduction in sexual risk behavior suggests that family-based interventions hold promise and warrant further development.