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Effects of Adolescents' Exposure to a School Based HIV Risk Reduction Intervention in Northern Malawi: A Quasi Experiment to Test Effectiveness for the HIV Risk Reduction Model

65 Pages Posted: 25 Sep 2018

See all articles by Marisen Mwale

Marisen Mwale

Mzuzu University

A.S. Muula

University of Malawi



Introduction: Malawi with a national HIV prevalence of 8.8% has registered successes in ART coverage and reduced mother to child HIV transmission through Option B. Similar programming successes have however not been registered in incidence outcomes among young people ages 12 - 24 years. While the national prevalence dropped from 10.6% in 2010, the 15-24 years prevalence rose from 3.6% to 5.9% by 2015. We therefore investigated whether a Risk Reduction Behavioural Intervention could improve HIV risk reduction outcomes in selected schools in Northern Malawi.  

Methods: We employed a quasi-experimental non-equivalent control group design to compare intervention participants (n = 158) with participants involved in a placebo (n = 147). The intervention participants were subjected to an HIV risk reduction package while the control participants were subjected to a Health promotion package focusing on malaria and tuberculosis prevention. The primary outcome was HIV risk reduction (composite index). Additional outcomes included; sexual behaviour, condom use, self-efficacy, knowledge and VCT /MMC behaviours.  

Results: At 8 months, those in the intervention group were .018 times less likely to be at heightened risk of HIV than those in the comparison group (odds ratio [OR]= .018, 95% confidence interval [CI]= .008, .042). Although there were no changes registered in abstinence efficacy, MMC intention and reported VCT uptake, the intervention lowered odds of reported sexual behaviour (OR= .045; 95% CI= .010, .045); increased odds of reported condom use (OR= 3.489, 95% CI=.963, 12.645) and lowered odds of multiple partnering (OR= .045; 95% CI=.019, .107). Increases in condom efficacy and faithfulness efficacy were also registered.  

Conclusion or Interpretation: The HIV Risk Reduction Model through behavioural, efficacy and skills building can lead to remarkable improvements in HIV risk reduction and prevention outcomes among adolescents in Malawi. Scaling up the intervention could potentially reduce HIV risk taking and incidence.  

Funding: The study is not externally funded. No government funding or award from charitable foundations was obtained.

Declaration of Interest: The authors declare that they have no competing interests.

Ethical Approval: Ethics approval for the study was granted by the University of Malawi College of Medicine [ref# : P.01/16/1847]. The quasi experiment was initially retrospectively registered as a RCT with PACTR on 12 December 2016. Informed consent for the study was obtained from all study participants including parental or guardian consent for respondents below age 18 as the study unfolded from cross-sectional situation analysis through to the quasi experiment in line with statutes guiding research with human participants and minors such as the Helsinki Declaration and Charter of Fundamental Rights of the EU. Consent to

Keywords: Adolescent, Intervention, HIV and AIDS, Quasi experiment, Malawi

Suggested Citation

Mwale, Marisen and Muula, A.S., Effects of Adolescents' Exposure to a School Based HIV Risk Reduction Intervention in Northern Malawi: A Quasi Experiment to Test Effectiveness for the HIV Risk Reduction Model (August 16, 2018). Available at SSRN: or

Marisen Mwale (Contact Author)

Mzuzu University ( email )

Private Bag 201
Luwinga, Mzuzu 2

A.S. Muula

University of Malawi

Chancellor College
Mathematical Sciences
Zomba, 265