Developing and pretesting a sexual reproductive health (SRH) school health promotion intervention (Safer Choices program) in rural South Africa: Study Protocol.

BACKGROUND: Young people remain at highest risk of HIV, sexually transmitted infections (STIs) and early pregnancy. The WHO Global School Health Initiative acknowledges the opportunity to promote effective health interventions within the sustainable infrastructure of schools. Safer Choices is a school-based multiple-component whole-school intervention effective in reducing sexual risk behaviours and preventing HIV, STIs and pregnancy among high-school learners. The overall aim of this study is to adapt and evaluate a Safer Choices program to improve uptake of sexual reproductive health (SRH) and HIV-prevention amongst 15-19-year-old learners in rural KwaZulu-Natal, South Africa. METHODS: This study will use a mixed-method study design guided by the MRC-framework for development and evaluation of complex interventions. We will use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to document modifications to Safer Choices. The study will be conducted across six purposively selected high schools in uMkhanyakude district. The study will be divided into three work-packages (WP): WP1 to adapt and refine Safer Choices to context using participatory research methods; WP2 to pilot and assess acceptability and feasibility of the adapted intervention followed by a process evaluation to understand reach, uptake, acceptability and feasibility of intervention. We will conduct pre/post intervention surveys with 390 randomly selected learners aged 15-19 to measure exposure, satisfaction, changes in self-reported SRH and HIV-risk behaviours. WP3 will include collection of exploratory data on the effect of the intervention on improving resilience and uptake of HIV-prevention and SRH services 60-days post-intervention delivery. DISCUSSION: This study protocol paper reports the details of our design for adaptation and evaluation of Safer Choices, with the aim of informing efforts elsewhere and scale-up of this evidence-based intervention. Integrating Safer Choices with SRH and HIV services will likely amplify its effectiveness, offering a holistic framework that addresses the multifaceted nature of HIV prevention.