# Multilevel Comprehensive HIV Prevention for South African Adolescent Girls and Young Women

> **NIH NIH UH3** · UNIVERSITY OF ILLINOIS AT CHICAGO · 2024 · $292,844

## Abstract

ABSTRACT
 Reducing new HIV and STI infections among South African (SA) adolescent girls and young women
(AGYW) is global public health priority.1 SA has world's largest HIV epidemic,2, 3 and SA AGYW acquire
HIV at twice the rate of and seroconvert on average 5 – 7 years earlier than male peers.3 As new infections
continue to outpace access to and availability of PrEP and ART, primary prevention remains the most
viable strategy to stem new transmissions.1, 4, 5 SA efforts to prevent HIV transmission in youth focus mostly
on individual-level behavior change,6-8 but AGYW’s persistent HIV disparities are explained by broad social
and structural inequities that shape and constrain HIV-risk behaviors.9-14 Comprehensive HIV prevention
packages that are integrated, synergistic, and tailored to the local epidemiology and cultural context are
likely to achieve and sustain maximum reductions in HIV-risk.15-22 Female caregivers (FC) are an untapped
resource in the HIV prevention toolbox23, 24 and offer a novel opportunity to strengthen AGYW prevention
efforts. AGYW may also be change agents for their FC who want to be positive role models for AGYW, and
thus, adopt HIV prevention behaviors, including HTC and PrEP. Guided by an ecological framework, our
highly experienced multidisciplinary team will evaluate the effectiveness and cost-effectiveness of IMARA-
SA, a multilevel, innovative, family-based HIV prevention program that targets individual, social, and
structural drivers of risk to decrease HIV and STI incident infections, reduce risky sexual behavior, and
increase HTC and PrEP uptake (where appropriate) in AGYW and FC. IMARA previously demonstrated a
43% reduction in incident STI at 12-month follow-up among Black 14-18 year-old girls in the US,25 and the
curriculum was carefully and systematically adapted to the South African context (IMARA-SA).26, 27 This
study will be integrated into the adolescent-friendly services at DTHF in the Western Cape metropolitan
area facilitating sustainability if effective. We will conduct a 2-arm RCT with 645 15-19 year-old AGYW and
FC comparing IMARA-SA to a time-matched family-based health promotion program (HP). FC and AGYW
will complete baseline, 6-, and 12-month assessments, including testing for three STIs. We will offer HTC
and PrEP at each assessment and track uptake and linkage to care. AGYW and FC who test positive for
a STI and/or HIV will receive free treatment at DTHF. We will collect data to determine the costs of IMARA-
SA. Analyses will compare AGYW and FC across the intervention and control programs on sexual risk
taking, STI and HIV incidence, PrEP and HTC uptake, and theoretical mediators. The study answers an
urgent need to evaluate the effectiveness and cost-effectiveness of combination HIV prevention packages
for AGYW to achieve an AIDS-free generation.

## Key facts

- **NIH application ID:** 11117433
- **Project number:** 3UH3HD096875-05S2
- **Recipient organization:** UNIVERSITY OF ILLINOIS AT CHICAGO
- **Principal Investigator:** Linda-Gail Gail Bekker
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $292,844
- **Award type:** 3
- **Project period:** 2018-09-01 → 2024-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11117433

## Citation

> US National Institutes of Health, RePORTER application 11117433, Multilevel Comprehensive HIV Prevention for South African Adolescent Girls and Young Women (3UH3HD096875-05S2). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/11117433. Licensed CC0.

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