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 & Behavior Quasi-experimental 304 Zimbabwe 12-14 years GRS 4 sessions

8 hours

24 Peacock-Villada et al. 2007 New Dir for Youth

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

23 Maro et al. 2009 Scand J Med Sci Sports

Quasi-experimental 764 Tanzania 12-15 years EMIMA/KAO 8 weeks

25 Rhodes et al. 2009 AIDS Education and Prevention

Quasi-experimental 222 USA mean age:

29 years HoMBReS 18 months

18 Fuller et al. 2010 British Journal of Sports Medicine

Quasi-experimental 370 South Africa 11-15 years Football-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. 2011 British Journal of Sports Medicine Pre/Post 389 Mauritius 12-15 years 11 For Health 11 sessions

16.5 hours

19 Fuller et al. 2011 British Journal of Sports Medicine Pre/Post 395 Zimbabwe 10-14 years 11 For Health 11 sessions

16.5 hours

21 Kaufman et al. In press AIDS Care Quasi-experimental 140 Dominican

Rep. 10-20 years GRS 5 sessions 10 hours

29 Rajan et al. 2008 136th APHA Annual Meeting Pre/Post 2,197 Ethiopia 13-24 years Sport for Life^

Youth Action Kit^24-30

activities

26 Gray et al. 2009 IV SA AIDS Conference

Quasi-experimental 478 South Africa 13-18 years Extra Time

Magazine^Just

magazine

20 Kaufman et al. 2010 XVIII International AIDS Conference Cross-sectional 246 Zimbabwe 15-19 years GRS 10 hours

20 Kaufman et al. 2010 XVIII 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 360 Southern Sudan 14-25 years Sports for Peace

and Life^ 15 activities

8 weeks

27 Wardell 2009 Author Quasi-experimental 94 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 GRS 8 sessions 4 weeks

31 Braunschweig 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