Sport-based HIV prevention

• HIV remains pressing threat to young people– 34M infected, 2.5M new infections per year– About 35% of infections are among young people – Limited effectiveness of youth prevention efforts– Urgent need for effective prevention work

• Increasing use of sports-based HIV prevention– Dozens of organizations and funders across the world

• e.g. Grassroot Soccer, Kicking AIDS Out, MYSA, Parivartan• USAID, Nike, EJAF, MAC AIDS Fund, Comic Relief, Barclays

– Programs use sports themes, activities, role models

– Growing evidence base on effectiveness

Assessing the evidence of sport-based HIV prevention through a systematic review

Zachary A. Kaufman, MScPhD Candidate, LSHTM

Systematic review objectives

• To assess and synthesize the evidence

of effectiveness for SBHP interventions

• To identify gaps in existing research in

order to inform future studies

Methods• Inclusion criteria

– Assessing SBHP effectiveness quantitatively– Interventions using sport at least partially– Interventions aimed at preventing HIV– RCTs, quasi-experimental, pre/post, cross-sectional

• Study quality appraisal– Adapted Newcastle-Ottawa scale (NOS)

• Analysed evidence strength across outcomes– Knowledge, attitudes, communication, behaviour– Service uptake, biological outcomes (HIV, HSV, etc)– Sensitivity analysis: restricted to published studies

Included studies (n=21)Ref Authors Year Source Study Design N Country Age group Intervention Length K A C B S Bio

16 Clark et al. 2006 AIDS & BehaviorQuasi-

experimental304 Zimbabwe 12-14 years GRS

4 sessions 8 hours

24Peacock-Villada et al.

2007New Dir for Youth

DevelopmentPre/Post 274 Zambia 10-18 years GRS/Resiliency 6 weeks

23 Maro et al. 2009Scand J Med Sci

SportsQuasi-

experimental764 Tanzania 12-15 years EMIMA/KAO 8 weeks

25 Rhodes et al. 2009AIDS Education and Prevention

Quasi-experimental

222 USAmean age: 29 years

HoMBReS 18 months

18 Fuller et al. 2010British Journal of Sports Medicine

Quasi-experimental

370 South Africa 11-15 yearsFootball-For-

Health11 sessions 16.5 hours

17 Delva et al. 2010 AIDS Care Cross-sectional 892 Kenya 12-24 years MYSA Varied

19 Fuller et al. 2011British Journal of Sports Medicine

Pre/Post 389 Mauritius 12-15 years 11 For Health11 sessions 16.5 hours

19 Fuller et al. 2011British Journal of Sports Medicine

Pre/Post 395 Zimbabwe 10-14 years 11 For Health11 sessions 16.5 hours

21 Kaufman et al. In press AIDS CareQuasi-

experimental140

Dominican Rep.

10-20 years GRS5 sessions 10 hours

29 Rajan et al. 2008136th APHA

Annual MeetingPre/Post 2,197 Ethiopia 13-24 years

Sport for Life^ Youth Action Kit^

24-30 activities

26 Gray et al. 2009IV SA AIDS Conference

Quasi-experimental

478 South Africa 13-18 yearsExtra Time Magazine^

Just magazine

20 Kaufman et al. 2010XVIII International AIDS Conference

Cross-sectional 246 Zimbabwe 15-19 years GRS 10 hours

20 Kaufman et al. 2010XVIII International AIDS Conference

Cross-sectional 307 Botswana 15-19 years GRS 10 hours

22 Kruse 2006 NORAD Cross-sectional 80 Zambia 14-18 years KAO Unclear

15 Mercy Corps 2007 mercycorps.org Pre/Post 280 Liberia 16-30 years Yes to Soccer^14 activities

6 weeks

15 Mercy Corps 2007 mercycorps.org Pre/Post 360Southern

Sudan14-25 years

Sports for Peace and Life^

15 activities 8 weeks

27 Wardell 2009 AuthorQuasi-

experimental94 St. Lucia 10-16 years

Football For Lives^

Unclear

30 Kim et al. 2010 Author Pre/Post 69 USA 10-15 years Grassroot Project^ 8 weeks

28 Luppe 2010 Author Pre/Post 61 South Africa 9-20 years GRS8 sessions 4 weeks

31Braunschweig et al.

2011 Author Pre/Post 612 South Africa 14-17 years Generation Skillz^ 11 sessions

^ Intervention adapted from GRS curriculum Outcome reportedly assessed in this study

*K=Knowledge; A=Reported attitudes; C=Reported communication; B=Reported behaviours; S=Service uptake; Bio=Biomarkers

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Outcomes Assessed*Intervention DetailsStudy Details

No randomised controlled trials.

No studies with biomarkers.

Figure 2: SBHP effects on knowledge

Figure 3: SBHP effects on communication

Conclusions on effectiveness of SBHP

• Overall strong evidence of effect on:– HIV-related knowledge– HIV-related communication

• Overall weak evidence of effect on:– HIV-related attitudes– Reported sexual behaviour

• Generally low-quality studies to date– Need stronger methodology

Conclusions: gaps in research

• Need stronger methodology– Randomisation: in sampling and allocation– Longer-term follow-up– More objective, rigorous outcomes

• Effects on service uptake?– Does SBHP increase HCT uptake?– Can SBHP increase MMC uptake?

• Effects on biological outcomes?– Does SBHP reduce HIV, STI incidence?

Questions and Discussion