Approximately 40% of girls in Ethiopia are married before the age of 18, and age at sexual debut and age at first birth is closely linked to marriage. While many girls' future aspirations include motherhood, the timing of these events is often outside their control. Through PSI's flagship project, Adolescents 360, Human-Centered Design, was used to develop an intervention called Smart Start. Smart Start engages young married couples in rural Ethiopia to start planning their futures. Smart Start teaches couples how financial planning and reaching financial stability can help them understand how delayed first birth and spaced pregnancies facilitate improved savings to pursue their shared life goals. Because it was challenging to engage husbands in Smart Start counseling sessions, Smart Start Plus was developed to increase husbands' engagement in family planning. Smart Start Plus was designed to help men learn more about modern contraceptive methods to support their wives better to use contraception. Husbands of women aged 15-24 are approached by male community leaders who they respect and are invited to attend a group session during a time that is convenient for them. Qualitative findings showed positive responses from both husbands and wives. Husbands reported learning more about contraceptive options and their benefits. Young women verified that having their husbands attend sessions reduced misinformation and resulted in more support for their contraceptive choices. The husband adaptation approach showed higher contraceptive uptake rates when compared to non-husband adaption sites (83% vs. 52%).

In 2020, Breakthrough ACTION Guinea, in consultation with Guinea's Service National de la Promotion de la Santé, launched Parents Fiers (Proud Parents), a three-month social and behavior change communication (SBCC) campaign, in three regions. The campaign promoted family planning for birth spacing, routine child vaccination, male engagement, and COVID prevention during health visits. The campaign disseminated messages via multiple communication channels, including radio spots, interactive radio programs, audio spots via mobile phones, and billboards. Due to COVID restrictions as well as financial and time constraints, at the end of the campaign an interactive voice response (IVR) survey via mobile phones assessed campaign exposure as well as changes in intention to vaccinate one's children and to use family planning for spacing intention. 

Among survey respondents (N= 3,012), 75.56% reported exposure to vaccination/family planning messages in the previous 3 months. At 57%, radio was the only channel that reached over 45% of the sample, suggesting that no one communication channel alone would reach the overwhelming majority of individuals. Multivariate regression analysis found that individuals exposed to 3 or 4 channels had 2.18 and 2.08 greater odds, respectively, of intending to use family planning for birth spacing, compared to individuals reporting no exposure (p<0.001). Study findings reinforces the importance of investing resources in creating multi-channel SBCC campaigns and highlight the value of measuring intermediate outcomes, such as intention, for SBCC campaigns. The presentation will also discuss the benefits and challenges of using IVR technology in evaluation research.   

Involvement of global and local stakeholders in programmatic decision-making is needed for systematic adaptations and improvements in SBCC programs. One engagement strategy, responsive feedback (RF), establishes opportunities for reflection and discussion among project designers, implementers, researchers and policymakers, with the aim of identifying necessary program modifications for enhanced project impact, sustainability and scale. The Growing Up GREAT! (GUG) project, a gender-transformative sexual and reproductive health (SRH) program in Kinshasa, DRC, used RF approaches to engage multisectoral government partners and adapt program design throughout the project lifecycle. These RF approaches included rapid qualitative studies, a scalability assessment, and quarterly learning meetings with a multi-sectoral Stakeholder Reference Group (SRG). Care was taken from project onset to establish ongoing working relationships with members of the SRG, who included staff members of government and civil society organizations, including the SRG chair from the National Program for Adolescent Health (MOH/PNSA). The SRG was ultimately responsible for institutionalizing GUG in government policies and platforms and building capacity of community-based organizations to adopt intervention activities. GUG's donors were committed to RF and documentation of learning and adaptation for increased impact. Emphasis was also placed on establishing and maintaining close collaboration with the DRC's Ministries of Education and Health throughout the project. Overall, we find that multisectoral engagement with international and local stakeholders is critical for the integration and scale of SBCC approaches, especially norms-shifting programs such as GUG, which seek to catalyze transformational change within complex, dynamic systems.

HIV testing uptake remains suboptimal, particularly among men, due to fear, stigma and negative clinic experiences. Approximately, 92% of men living with HIV have been tested for HIV and an estimated third (31%) of men diagnosed with HIV are not engaged in care. HIV self-screening (HIVSS) has demonstrated high uptake among men, but more information is needed on the best models to reach men. 

We explored the experiences of male peer navigators openly living with HIV (known as coaches), with the aim of understanding how they deliver HIVSS kits. The Coach Mpilo intervention has been designed to address these gaps. Coach Mpilo is a people living with HIV (PLHIV) peer-based case management intervention designed for men living with HIV to serve as true peers for linkage and adherence for newly diagnosed men, men who never initiated treatment and men who have been lost to care. Coaches are trained to reframe the HIV story, dispel negative emotional associations around failure, weakness, guilt, shame, secrecy, and isolation, and replace them with positive emotional associations around winning, strength, responsibility, confidence, openness, normalcy, and acceptance. 

Improving engagement and/or re-engagement among men and linking them to HIV services, is essential for their health outcomes and for epidemic control. Multiple distribution strategies demonstrated the potential for increasing the uptake of HIVST. Coaches helped address barriers to access and provided support and encouragement for HIVSS uptake. 

Sexual violence against women occurs worldwide. Prevention programs that treat men as "allies" and integrate a bystander framework are emerging in lower-income settings but evidence of effectiveness is conflicting. We tested the impact of GlobalConsent on sexually violent behavior and prosocial bystander behavior among university men in Vietnam in a randomized controlled trial at two universities. Consenting heterosexual or bisexual men 18-24 years matriculating in September 2019 (n=793) were enrolled and assigned to GlobalConsent or an attention-control adolescent health education program (AHEAD). GlobalConsent is an adapted, theory-based, six-module web-based intervention with diverse behavioral-change techniques and a locally produced serial drama. Self-reported sexually violent behaviors toward women in the prior six months and prosocial bystander behaviors in the prior year were measured at zero, six, and 12 months. At baseline, notable percentages of men reported any sexually violent behavior in the prior six months. At endline compared to baseline, men receiving GlobalConsent had 1.26 times the odds of reporting a high level (at least two acts) of sexually violent behavior, and 0.67 times the odds of reporting any bystander behavior. The corresponding odds ratios for the AHEAD peers were less favorable, 2.67 and 0.45.  Compared to a health attention-control condition, GlobalConsent has sustained favorable impacts on sexually violent behavior and prosocial bystander behavior among matriculating university men in Vietnam, who otherwise would face increasing risks of sexually violent behavior, showing promise for scale-up and adaptation.