If I Were Thabo: Optimisation and feasibility trial of a gender transformative sexual and reproductive health intervention in South Africa and Lesotho

撒哈拉以南非洲关于青少年性健康和生殖健康的研究主要侧重于预防意外怀孕和预防艾滋病毒感染。然而，这项工作很少关注男孩和年轻男性，也很少积极针对他们。性别变革方法，或寻求改变性别规范和权力关系的方法，被誉为破坏可能导致不良健康结果和推动艾滋病毒感染和青少年怀孕的潜在因素的一种方法。在南非和莱索托这两个资源匮乏、艾滋病和青少年怀孕率都很高的国家，我们的研究采用了一种性别变革的方法，旨在以创新和包容的方式满足对本地化解决方案的迫切需求。本研究的目的是通过调整“如果我是杰克”计划，在南非和莱索托使用，并以“如果我是塔博”为名，来解决证据差距问题。最初的项目是在英国开发的，是一种针对教育背景下的青少年的群体干预，其中包括一部文化敏感的互动电影，讲述一个青少年发现他的女朋友意外怀孕的故事，以及一个关于参与者在他的位置上的感受和反应的引导讨论。该方案还附有青少年照顾者的教育材料和会议，目前的形式已被证明是可以接受和具有成本效益的。我们建议与青少年、家长、教师、社区成员和当地专家合作，在南非和莱索托这两个中低收入国家调整该方案。我们的目标是13-14岁的青少年，在大多数青少年性活跃之前，在青春期后期怀孕和性传播感染增加之前，这个年龄段仍有可能预防冒险的性行为。为了开发和测试干预措施，拟议的研究将包括两个阶段。首先，我们将与青少年、他们的父母和照顾者、教师、保健专业人员和其他主要社区成员合作，调整和优化联合王国提供的方案材料，以便在南非和莱索托使用。这将涉及在每个地点共同制作与当地有关和适当的干预材料。青少年将与研究人员和电影制作人合作，在每个网站编写、选角和开发新电影，并就文本材料的可接受性提出建议，并就针对照顾者的信息咨询他们的照顾者。教师、社区团体促进者和保健专业人员将对为方案促进者设计的材料提供反馈。此外，我们将要求青少年及其照顾者对下一阶段将使用的一些研究工具提供反馈。接下来，我们将在可行性集群随机试验中对该计划进行试点，以评估干预实施和评估设计在两国是否可行。作为这一阶段的一部分，我们将调查学校和社区团体中的青少年，其中一半将被随机选择接受干预，另一半将继续“正常做法”。我们将评估问卷是否捕获了这一群体的性健康和生殖健康结果的必要信息，包括与青少年怀孕、艾滋病毒和性传播感染有关的意图。我们还将评估实施该计划所需的程序是否运作良好。计划完成后，我们将采访青少年和其他利益相关者，了解他们对计划的看法，以及在学校和社区团体中实施是否可行，以及在这两种环境中阻碍或帮助实施的因素。基于这些结果，我们将决定是否可以在这两个地点进行更大规模的干预试验，以确定该计划是否有效地改善了这些国家青少年的性健康和生殖健康。

Research on adolescent sexual and reproductive health (SRH) in sub-Saharan Africa is heavily focused on preventing unintended pregnancies and preventing HIV infection. However, very little of this work focuses on, and actively targets, boys and young men. Gender-transformative approaches, or approaches that seek to shift gender norms and power relations, have been hailed as one way to disrupt underlying factors that can lead to poor health outcomes and drive HIV infection and adolescent pregnancy. Applying a gender-transformative approach in South Africa and Lesotho, across two low-resource settings with very high rates of both HIV and adolescent pregnancy, our research aims to meet an urgent need for localised solutions and do so in an innovative and inclusive way. The aim of this study is to address the evidence gap by adapting the If I Were Jack programme for use in South Africa and Lesotho, under the name If I Were Thabo. The original programme, developed in the UK, is a group-based intervention delivered to adolescents in educational settings, which includes a culturally sensitive interactive film about an adolescent who discovers that his girlfriend is unexpectedly pregnant, and a guided discussion about how participants would feel and react in his position. The programme is accompanied by educational materials and sessions for adolescents' caregivers, and has been shown to be acceptable and cost-effective in its current form. We propose to adapt the programme in two LMICs, South Africa and Lesotho, in partnership with adolescents, parents, teachers, community members and local experts. We will target adolescents aged 13-14, an age range where there is still potential to prevent sexual risk-taking before the majority of adolescents are sexually active, and before the increase in pregnancy and STIs reported in later adolescence. To develop and test the intervention, the proposed study will involve two phases. First, we will work with adolescents, their parents and caregivers, teachers, health professionals and other key community members to adapt and optimise the programme materials from the UK for use in South Africa and Lesotho. This will involve co-producing locally relevant and appropriate intervention materials in each site. Adolescents will work with researchers and filmmakers to write, cast and develop new films in each site, and advise on the acceptability of text-based material, and their caregivers will be consulted on caregiver-targeted information. Teachers, community group facilitators and healthcare professionals will provide feedback on materials designed for programme facilitators. In addition, we will ask adolescents and their caregivers to give feedback on some of the research tools that will be used in the next phase. Next, we will run a pilot of the programme within a feasibility cluster randomised trial to assess if the intervention implementation and evaluation design is feasible in both countries. As a part of this phase we will survey adolescents in schools and community groups, half of whom will be randomly chosen to receive the intervention and the other half of whom will continue with 'normal practice'. We will assess whether the questionnaires capture the necessary information on SRH outcomes for this group, including intentions relating to adolescent pregnancy, and HIV and STI infection. We will also evaluate whether the processes needed to implement the programme work well. After programme completion, we will interview adolescents and other stakeholders about their opinions of the programme and whether it is feasible to deliver in schools and community groups, and what will hinder or help the implementation in the two settings. Based on these results, we will decide if it will be feasible to do a larger trial of the intervention in both sites to see if the programme is effective in improving SRH for adolescents in these countries.