The Global Fund invested in a South African combination HIV prevention intervention for adolescent girls and young women (AGYW) aged 10 to 24 years from 2016 to 2019 in ten priority districts in South Africa. The concept of “combination implementation” has been defined as “the pragmatic, localized application of a package of evidence-based prevention interventions using optimized implementation and operational strategies to achieve high sustained uptake of good quality services . The three-year intensive, comprehensive HIV prevention intervention addressed factors that increase the risk of HIV acquisition and transmission among AGYW and promoted factors that increase their resilience in the face of the HIV epidemic. The combination intervention included behavioural, biomedical and structural HIV prevention programmes and was comprised of: (1) access to comprehensive HIV, TB and sexual and reproductive health (SRH) services and commodities, (2) rights-based sexual and reproductive health (SRH) education, (3) support to keep adolescent girls in school including homework help, (4) therapeutic services for abused children, (5) financial literacy and career development, (6) vocational programmes to promote economic empowerment, and (7) interventions to maximise social support and social capital. In addition, there was a (8) conditional cash incentive programme in two districts.
The HERStory Study is an evaluation of this intervention, conducted by the South African Medical Research Council (SAMRC) and partners. The primary objective of the HERStory Study is to determine the intervention impact on HIV incidence over a two-year period. Secondary objectives include assessing the intervention impact on the prevention of behaviours that put AGYW at risk of HIV and other sexually transmitted infections (STIs), and the impact of the intervention on the cognitions and social environments of AGYW. The HERStory Study quantitative evaluation study design includes two consecutive cross-sectional household surveys conducted two years apart, to detect changes in HIV incidence using a laboratory testing algorithm comprising the bio-assays for determining recent infections, the Limiting Antigen Avidity Enzyme Immunosorbent Assay (LAg Avidity EIA). A sample of 14000 AGYW aged 15 to 24 years per survey was planned, which gives 80% power to detect a 33% reduction in HIV incidence from 3% to 2% over two years. The study design also includes qualitative research to complement the quantitative evaluation, to provide an in-depth understanding of changes in risk and protective factors related to HIV acquisition among AGYW and to identify gaps and challenges in the intervention components and their implementation as well as ways to revise and improve the intervention and its implementation. This report only includes results of the first survey, conducted in 2017 to 2018. The qualitative findings and second survey results will be reported separately.