Assessing the Impact of a Small-Group Behavioral Intervention on Sexual Behaviors Among Adolescent Girls and Young Women in Lilongwe Malawi: A Quasi-Experimental Cohort Study

  • Nora E. RosenbergEmail author
  • Margaret W. Gichane
  • Dhrutika Vansia
  • Twambilile Phanga
  • Nivedita L. Bhushan
  • Linda-Gail Bekker
  • Audrey E. Pettifor
Original Paper


Adolescent girls and young women (AGYW) in sub-Saharan Africa are at high risk of many adverse sexual and reproductive health outcomes. Small-group interventions addressing underlying vulnerabilities may influence risky sexual behaviors associated with these adverse outcomes. Girl Power-Malawi assessed whether a facilitator-led, curriculum-driven small-group behavioral intervention impacted risky sexual behaviors among AGYW in Lilongwe, Malawi. Four Health Centers were selected; two were randomly assigned to provide the intervention. Two-hundred fifty AGYW 15–24 years old were enrolled in each clinic (N = 1000 total), followed for 1 year, and interviewed at baseline and endline. At both time points participants reported on two behaviors in the last month (vaginal sex and ≥ 2 sexual partners) and two behaviors in the last year (age-disparate relationships and transactional relationships). In intervention clinics, there were no declines in risk behaviors between baseline and endline. Endline behaviors were not less risky in intervention clinics than control clinics. This intervention did not have a positive effect on four risk behaviors over a 1-year period.


HIV Prevention Risk Adolescent Sexual behavior 



The study was funded by Evidence for HIV Prevention in Southern Africa (EHPSA), a DFID program managed by Mott MacDonald. NER is funded by the National Institute of Mental Health (R00 MH104154) and the National Institute of Allergies and Infectious Diseases (P30 AI50410). NLB was supported by the National Institutes of Health Fogarty International Center (R25 TW009340) and National Institute of Allergy and Infectious Diseases (T32 AI007001). TP is supported by the Malawi HIV implementation research scientist (M-HIRST) program (Fogarty International Center, D43TW010060). We would like to thank the District Health Office, especially Annie Kachigamba, for support on the Girl Power study. We would like to thank Maria Kapira, Atuweni Mtawali, and Rejoice Chisinga for facilitating the behavioral intervention sessions.

Compliance with Ethical Standards

Conflict of interest

Authors NER, MWG, DV, TP, NLB, LGB, and AEP declare that they have no conflict of interest.

Research Involving Human and Animal Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent or assent was obtained from all individual participants included in the study.

Supplementary material

10461_2019_2669_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 17 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.UNC Project, University of North Carolina at Chapel HillLilongweMalawi
  2. 2.Department of Health Behavior, School of Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Desmond Tutu HIV FoundationCape TownSouth Africa
  4. 4.Department of Epidemiology, School of Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA

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