Abstract
OBJECTIVE: To assess HIV testing and status disclosure rates and explore their associated predictors among young adolescents (10-17 years) who received health education through the Orphans and Vulnerable Children programme in Nimule, South Sudan. DESIGN: A pre-post evaluation study with data collected at baseline (December 2020) and at the endline (December 2022). SETTING: The study was conducted in Nimule, a densely populated periurban town characterised by high HIV prevalence and substantial cross-border movement between Uganda and South Sudan, making it a relevant setting for an HIV prevention project. INTERVENTION: The primary intervention was HIV risk education delivered through forty peer-led health clubs. Adolescents were screened for HIV risk factors and referred for HIV and other sexually transmitted infection testing at health facilities. PARTICIPANTS: The study included young adolescents aged 10-17 years recruited from HIV-affected households within 17 neighbourhoods in Nimule periurban town. Informed consent was obtained from both caregivers and adolescents. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was self-reported HIV testing and status disclosure. Binary logistic regression was used to assess the association between the study outcome variables and associated sociodemographic factors. RESULTS: A total of 557 (73.0%) of the 768 enrolled adolescents were surveyed at baseline and endline, including 301 (54.0%) females and 276 (46.0%) males. The median age was 14 years (IQR: 11-16) at baseline and 15 years (IQR: 12-17) at endline.HIV testing increased from 315 (56.7%) at baseline to 557 (100%). The odds of undisclosed HIV status were 49% lower at endline adjusted OR (aOR) 0.51 (95% CI 0.92, 0.67; p<0.001). Status disclosure was nearly universal, with 557 (100%) at baseline and 556 (99.8%) at endline. Male adolescents aOR 0.77 (95% CI: 0.59, 0.99; p<0.04) and those cared for by their siblings or other relatives were less likely to know their HIV status (aOR 0.59; 95% CI: 0.41, 0.84; p<0.003). CONCLUSIONS: Male gender and being cared for by siblings or other relatives were strong predictors of lower HIV testing and status disclosure. These findings underscore the importance of targeting efforts towards this category of adolescents in postconflict and resource-limited settings like South Sudan while leveraging peer-led HIV education interventions in conflict-affected settings.