Shoo T, Kamala B, Rosecrans K, Miller K, Al-Alawy H, Rwezahura P Families Matter! Program Increases Parent-Preadolescent Communication about Sex in Tanzania An Outcome Evaluation in Mtwara and Ruvuma Shoo T, Kamala B, Rosecrans K, Miller K, Al-Alawy H, Rwezahura P

Attribution and Disclaimer This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement No.1U2GGH001019-01. The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the CDC. 

Background Young Tanzanians are at risk of HIV infection (THMIS 2011-12) HIV prevalence among women 1.1% (15-17 years old) 6.6% (23-24 years old) Comprehensive HIV knowledge (15-24 years old) 40% women 47% men About half men & women aged 18-24 reported having sex before age 18 Studies from many countries, including Tanzania, suggest parents play an important role in preventing their children from engaging in risky sexual behavior (Kajula et al, 2014, Mlunde et al,2012, Mmbaga et al,2012)

Families Matter! Program Curriculum 1 Getting to know you and steps to understanding your child 2 Effective parenting 3 Sexuality education, sexual Health and parents as sex educators 4   Increasing comfort and skills in discussing sexuality issues 5 Discussing sexuality and handling peer pressure Evidence-based intervention promote positive parenting practices and effective parent-child communication on sexuality and sexual risk reduction parents and other caregivers of 9-12 year olds Ultimate goal: reduce sexual risk behaviors and delay onset of sexual debut. FMP was implemented in Ruvuma (Subira ward) and Mtwara (Nanyamba ward)

Objective To evaluate whether Families Matter! Program (FMP) increases parent-preadolescent communication about sex in the two wards Sexual education Heterosexual friendship Puberty Menstruation Sexual risk reduction Abstinence Peer pressure Condoms Sex Reproduction Maturity required for sex Family planning HIV/AIDS Other sexually transmitted infections (STIs)

Methodology Pre-post program evaluation 1-3 weeks before FMP 3 months after FMP Structured questionnaire Face-to-face interview Administered separately to parent/ guardian and 9-12 year-old child Six questions in each domain Each question scored 0-2 0 “No, never” 1 “Yes, once” 2 “Yes, more than once” Approved by the National Health Research Ethics Review Committee at the National Institute for Medical Research (Tanzania) and Centers for Disease Control and Prevention.

Data Analysis Analysis using SPSS v22 Descriptive statistics calculated to describe the study population Frequency of answers to each item calculated For each domain, score calculated Cronbach’s alpha calculated >0.7 considered internally consistent McNemmers test and Wilcoxon signed-rank test (a non-parametric test) were used to compare baseline and post-intervention scores 797 parent-preadolescent pairs enrolled at baseline 658 (83%) completed post-intervention questionnaire

Results

Parent Socio-Demographic Characteristics Mtwara Ruvuma Total    N (%) Sex Male 101 (30.7) 84 (25.5) 185 (28.1) Female 228 (69.3) 246 (74.5) 474 (71.9) Age 25-34 98 (29.8) 86 (26.1) 184 (27.9) 35-44 136 (41.3) 119 (36.1) 255 (38.7) 45-54 64 (19.5) 71 (21.5) 135 (20.5) 55+ 31 (9.4) 54 (16.4) 85 (12.9) Relationship Parent 271 (81.9) 247 (74.8) 518 (78.6) Other 58 (18.1) 83 (25.2) 141 (21.4) Education None 40 (12.1) 94 (14.3) Primary 260 (79.0) 276 (83.6) 536 (81.3) Secondary+ 15 (4.6) 14 (4.2) 29 (4.4) Occupation Farmer 317 (96.4) 322 (97.6) 639 (97.0) Others 12 (3.6) 8 (2.4) 20 (3.0) Total 329 (100.0) 330 (100.0) 659 (100.0) More female than men Mostly in the age group 35-44 Most were biological parents More caretakers/guardians in Ruvuma than Mtwara

Preadolescent Socio-Demographic Characteristics   Mtwara Ruvuma Total  N (%) Sex Male 152 (46.2) 167 (50.6) 319 (48.4) Female 177 (53.8) 163 (49.4) 340 (51.6) Age 9-10 204 (62.0) 176 (53.3) 380 (57.7) 11-12 125 (38.0) 154 (46.7) 279 (42.3) Total 329 (100.0) 320 (100.0) 659 (100.0)

Ever Talked about Sexual Education Topics

Ever Talked about Sexual Risk Reduction Topics

Baseline and Post-Intervention Communication Scores  Baseline score Post-intervention score Score difference Participants with score improvements Test for significance   Median (Q1,Q3) Mean %  P-value  Sexual education Parent 0 (0,1)  4 (1,10) 4.6 58 <0.0001 Preadolescent 2 (0,6) 2.9 54 Sexual risk reduction 2 (0,2)  8 (4,8) 5.2 81 1 (0,2)  4 (2,8) 3.2 56

Conclusions FMP increases parent-child communication Sexual education Sexual risk reduction May influence children to Delay sexual debut Reduce risky sexual behaviors and hence HIV new infections among youth

Acknowledgements FMP Participants MOHSW (NACP) TACAIDS RAS Ruvuma and Mtwara DED Songea WEO and VEO Head teachers Enumerators and supervisors T-MARC partners