Accelerating Sustainable Development Goals for South African adolescents from high HIV-prevalence areas: A longitudinal path analysis

Objective: To investigate the impact of interventions and circumstances (“accelerators”) on the achievement of targets across multiple Sustainable Development Goals (SDGs) for HIV-affected adolescents and examine cumulative effects on outcomes.

Methods: Prospective longitudinal data from 3401 adolescents from randomly selected census enumeration areas in two provinces with >30% HIV prevalence carried out in 2010/11 and 2011/12 were used to examine six hypothesized accelerators (positive parenting, parental monitoring, free schooling, teacher support, food sufficiency and HIV-/asymptomatic caregiver) targeting twelve outcomes across four SDGs, using a multivariate (multiple outcome) path model with correlated outcomes. The study corrected for multiple-hypothesis testing using the Benjamini-Hochberg procedure and tested measurement invariance across sex. Percentage predicted probabilities of occurrence of the outcome in the presence of the significant accelerators were also calculated.

Results: Sample mean age was 13.7 years at baseline, 56.6% were female. Positive parenting, parental monitoring, food security and HIV-/asymptomatic caregiver were variously associated with reductions on ten outcomes. The model was gender invariant. HIV-/asymptomatic caregiver was associated with the largest reductions. Combinations of accelerators resulted a percentage reduction of risk of up to 40%.

Conclusion: Positive parenting, parental monitoring, food sufficiency and HIV-/asymptomatic caregivers by themselves and in combination improve adolescent outcomes across ten SDG targets. These could translate to corresponding real-world interventions, which in combination may help governments in sub-Saharan Africa more economically to reach their SDG targets.