Factors influencing adolescent girls and young women’s participation in a combination HIV prevention intervention in South Africa

BACKGROUND: For interventions to reach those they are intended for, an understanding of the factors that influence their participation, as well as the facilitators and barriers of participation are needed. This study explores factors associated with participation in a combination HIV prevention intervention targeting adolescent girls and young women (AGYW) aged 15– 24-years-old, as well as the perspectives of AGYW, intervention implementers, and facilitators who participated in this intervention. METHODS: This study used mixed-methods approach with quantitative household survey data from 4399 AGYW aged 15–24-years-old in six of the ten districts in which the intervention was implemented. In addition, qualitative methods included a total of 100 semi-structured in-depth interviews and 21 focus group discussions in five of the ten intervention districts with 185 AGYW who participated in one or more of the key components of the intervention, and 13 intervention implementers and 13 facilitators. Thematic analysis was used to explore the perspectives of participating and implementing the intervention. RESULTS: Findings reveal that almost half of AGYW (48.4%) living in the districts where the intervention took place, participated in at least one of the components of the intervention. For both 15–19-year-olds and 20–24-year-olds, factors associated with increased participation in the intervention included being HIV negative, in school, never been pregnant, and having had a boyfriend. Experiencing intimate partner violence (IPV) and/or sexual violence in the past 12 months was associated with increased levels of participation in the intervention for 20–24-year-olds only. In our analysis of the qualitative data, facilitators to participation included motivating participants to join the interventions through explaining the benefits of the programme. Barriers included misguided expectations about financial rewards or job opportunities; competing responsibilities, interests or activities; family responsibilities including childcare; inappropriate incentives; inability to disrupt the school curriculum and difficulties with conducting interventions after school hours due to safety concerns; miscommunication about meetings; as well as struggles to reach out-of-school AGYW. CONCLUSION: Designers of combination HIV prevention interventions need to address the barriers to participation so that AGYW can attend without risking their safety and compromising their family, childcare and schooling responsibilities. Strategies to create demand need to include clear communication about the nature and potential benefits of such interventions, and the inclusion of valued incentives.Additional file 1. COREQ template. Consolidated criteria for reporting qualitative studies (COREQ): 32-item checklistAdditional file 2. Qualitative topic guide. Interview and focus group discussion guides for AGYW (intervention recipients) and programme implementers.Additional file 3. HERStory Survey for YWG aged 15–24 (English). The full questionnaire for the quantitative HERStory study for AGYW aged 15–24 years.Additional file 4. HERStory Qualitative Study Codebook. Pre-determined codebook used for analysis of qualitative data.The President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention under the terms of Cooperative Agreement 1U2GGH001150, the Social Impact Bond of the South African Medical Research Council funded by the Global Fund, the South African Medical Research Council through its Division of Research Capacity Development under the Intra– mural Post-doctoral Fellowship programme and the CIPHER GROWING THE LEADERS OF TOMORROW grant from the International AIDS Society.http://www.biomedcentral.com/bmcpublichealthpm2021Internal Medicin