The Government of Kenya plans to scale-up an adolescent-focused cash 'plus' programme to improve educational attainment and prevent adolescent pregnancy. We aimed to estimate the programme's impacts, economic returns, and cost-effectiveness using model-based economic evaluation. We modelled the delivery of conditional cash transfers 'plus' adolescent clubs, community conversations, parenting support and psychosocial support to poor adolescents in nine selected counties from 2026 to 2029. Two scenarios were compared: a baseline in which intervention variables remained constant at 2025 levels, and an immediate scale-up sustained throughout 2026-2029. Human development impacts were simulated using an integrated modelling framework. Gains in years of schooling were projected with an education transition model, while reductions in adolescent pregnancy, child marriage, and experiences of violence were estimated with a deterministic age-cohort transition model. Economic returns to schooling were calculated with Mincerian earnings functions. Model parameters were derived from rigorous impact evaluations, nationally representative surveys, and Kenya's national social registry. The four-year intervention, costing US$46.1 million, is projected to reach 140,000 adolescents, and compared with the baseline, generate an additional 74,900 (+7%) years of schooling; and avert 1,420 (-8%) adolescent pregnancies, 1,500 (-11%) child marriages, 2,970 (-3%) experiences of sexual violence, and 21,800 (-8%) experiences of emotional/physical violence. Furthermore, the intervention is projected to generate US$318 million in discounted lifetime labour earnings, representing a seven-fold return on investment. The estimated cost was US$567 per additional year of schooling, and US$109 when benefits across multiple outcomes were considered, comparing favourably with other adolescent education interventions. Findings were robust to sensitivity analyses, with a >98% probability that returns exceeded programme costs. These findings suggest that scaling up an adolescent focused cash 'plus' programme could substantially improve adolescent human development, while delivering strong economic returns and good value for money.

OBJECTIVES:Low-level viremia (LLV) has been associated with an increased risk of virological failure among adults on antiretroviral therapy (ART). However, evidence on the clinical implications of LLV among adolescents living with HIV remains limited. This study aimed to assess the prevalence and predictors of LLV and to determine the association between LLV and subsequent virological failure. METHODS:We analysed data from an integrated prospective cohort of adolescents living with HIV linked to the National Institute for Communicable Diseases (NICD) data warehouse in South Africa. Using routine viral load data from 2015 to 2021, we estimated the prevalence of LLV at the first test. We then used mixed-effects logistic regression to identify socio-demographic factors associated with LLV. Among adolescents with at least three viral load measurements, we assessed the association between LLV and subsequent virological failure using a Cox proportional hazards model in RStudio. RESULTS:Among 730 adolescents, the prevalence of LLV ranged between 10.4% and 20.1%. Older adolescents aged 15-19 years (aOR: 1.92; 95% CI: 1.44-2.55) and those ≥20 years (aOR: 1.69; 95% CI: 1.12-2.57) had significantly higher odds of LLV compared to those 10-14 years. Among 617 adolescents, 13.3% had LLV, of which 17.1% subsequently progressed to virological failure. Those experiencing LLV were associated with a four-fold (aHR 4.91; 95% CI: 2.46-9.79) increased hazard of virological failure compared to suppressed adolescents. CONCLUSIONS:The prevalence of LLV among adolescents living with HIV on ART is high and LLV strongly predicts virological failure. Enhanced adherence support for adolescents with LLV is needed to minimize the risk of long-term virological failure.

Background Globally, there were approximately 21 million adolescent pregnancies in 2019, of which half were unplanned. Adolescent pregnancy is an issue of social and health inequity: it hinders young mothers’ chances of continuing with school, and is associated with higher exposure to domestic violence, HIV, and food insecurity. While schooling is a well-known determinant of health, an implementation gap exists in supportive provisions. While protective factors such as school engagement enable improved health outcomes and educational attainment for adolescent mothers, yet limited evidence exists on how school and community stakeholders can can adapt to support these learners. This formative, participatory research engaged young people's expertise to inform implementation priorities for supporting adolescent mothers' educational attainment. Methods This study aimed to co-construct potential support package components, in partnership with young people from a community-academic partnership called a “Teen Advisory Group”. We conducted participatory priority-setting research with a Teen Advisory Group (TAG) of young research advisors (n = 13, ages 21–25) in Eastern Cape, South Africa, over eight weeks in July-August 2022. Using a socio-ecological framework and positive youth development theory, data co-creation occurred across three stages: (1) introductory phone calls; (2) remote engagement through a closed Facebook group (n = 7) with weekly activities; and (3) a 3-day face-to-face participatory design workshop featuring gallery walks, gender-separated group interviews, and arts-based "dreamy care package" activities. Evidence-based comic storylines informed exploratory discussions. Activities were conducted in English and isiXhosa, and analyzed using reflexive thematic analysis combining deductive and inductive approaches, validated through member-checking with advisors (n = 10). Results Adolescent pregnancy exposed young mothers to various forms of stigma, at home, amongst peers, and from the community. Young research advisors described support figures such as social workers and healthcare professionals as important figures who would help them from dropping out of school and prevent further pregnancies. Family-level support mostly helped ease the burden of childcare for the young mother. Staying motivated and focused by setting goals for themselves also kept pregnant and mother learners motivated to continue with school. The young mothers suggested that the government could support adolescent mothers by subsidising formal childcare and some baby essentials during early motherhood. Conclusions Our findings emphasize a multi-faceted approach to supporting pregnant and mother learners. This includes stigma reduction interventions at the household and community level, enhanced teacher training to provide psychosocial and health support, and the provision of accessible and affordable childcare to facilitate a return to school. Furthermore, our results underscore the need for stronger social support systems, multi-sectoral collaboration to integrate healthcare and social work services in schools, and the adoption of youth-led participatory approaches to ensure interventions are relevant and effective.

Adolescent girls and young women (AGYW) living with HIV face heightened risks of mental distress, which may be compounded by exposure to violence and socioeconomic vulnerabilities. This study examined whether social protection moderates the relationship between violence exposure and mental distress among AGYW living with HIV in Eswatini, Lesotho, and Namibia. Using data from the Violence Against Children and Youth Surveys (VACS), we analysed 1,006 AGYW aged 15–24. Mental distress was measured using the Kessler Psychological Distress Scale (K6), with scores ≥ 5 indicating moderate-to-severe distress. Correlates included lifetime sexual, physical, or emotional violence and access to social protection from government or non-governmental programs. Findings showed that sexual (aOR = 1.84, 95

In resource-constrained settings, structural and material inequalities shape children’s developmental opportunities, yet developmental pathways remain diverse even within shared hardship. This study examined developmental continuity and variation in cognitive trajectories among children born in adversity and assessed whether maternal structural positioning and household material conditions were associated with developmental progression. Data were drawn from 742 children born to adolescent mothers in the large longitudinal cohort in the Eastern Cape, South Africa. Cognitive functioning was assessed using the Mullen Scales of Early Learning (MSEL) at baseline and the Kaufman Assessment Battery for Children (KABC-II) at follow-up. Baseline functioning predicted later cognitive placement, indicating developmental continuity (B = 0.074, SE = 0.030, p = .015). Lower maternal educational attainment was associated with more constrained developmental progression (B = −0.097, SE = 0.023, p < .001), and maternal not in education, employment, or training (NEET) status also predicted constrained trajectories (B = −0.200, SE = 0.049, p < .001). In contrast, consistent access to basic household necessities was associated with more favourable developmental trajectories (B = 0.024, SE = 0.009, p = .012). These findings indicate that variation in children’s developmental trajectories reflects differences in structural positioning and household material conditions. Supporting adolescent mothers’ engagement in education and access to stable resources may represent an important pathway for improving child developmental outcomes.

Background. Safe Spaces interventions are mentor-led regular group meetings facilitated in a designated space or location, widely used across Africa to support health and well-being of adolescent girls and young women (AGYW). However, there is substantial variation in their intervention design, delivery, and outcomes. Methods. We conducted a scoping review of studies quantitatively reporting at least one of three outcomes of Safe Spaces interventions targeting AGYW aged 10-24 years in Africa: child marriage, adolescent pregnancy, and school enrolment. Data were extracted on study characteristics, participant populations, intervention components, delivery approaches, and outcomes. Findings were synthesised descriptively using narrative summaries, tables, and figures. Findings. Thirty-eight intervention studies (from 51 publications) were included. Studies were conducted across 19 African countries. Interventions were predominantly multi-component, with almost half (47%) evaluating three or more intervention arms. Common intervention components included: life skills and financial literacy training (37 studies), enabling environment activities (22 studies), financial support (20 studies), and economic empowerment (18 studies). Most studies focused on 15-19-year-old adolescent girls. Considerable heterogeneity was observed in intervention design, delivery characteristics, and outcomes assessed, and most studies did not report age-disaggregated findings (e.g., younger versus older adolescents). Interpretation. The evidence base on Safe Spaces interventions in Africa is substantial and highly heterogeneous. Strengthening the comparability of research design, consistency of reporting, and increasing geographical spread remain important for advancing the evidence base on the usefulness and applicability of Safe Spaces interventions in policy and practice in Africa.

The mental health of young women at risk of HIV exposure and early pregnancy, remains understudied. This study contributed to this research gap by exploring the mental health experiences of young mothers affected by HIV in South Africa. We conducted 17 semi-structured interviews with 18-24-year-old young mothers in the Eastern Cape, South Africa, 12 of whom were living with HIV. Interviews were recorded, transcribed, and analysed using a reflexive thematic approach. Young mothers showed diverse understandings and articulation of their day-to-day experiences of mental well-being. Many participants felt overwhelmed and stressed by the sudden transition into motherhood, as they were unprepared for the significant changes it brought into their lives. Additionally, this stress was heightened for young mothers living with HIV, who faced increased vulnerability to poor mental health, particularly where early motherhood intersected with the stigma associated with HIV.

BACKGROUND:Adolescents and youth in Eastern and Southern Africa face significant health challenges, including high HIV prevalence, requiring comprehensive, youth-responsive healthcare. Peer provider interventions, where young people deliver health services are increasingly implemented, but evidence on effectiveness is fragmented. OBJECTIVES:This scoping review aimed to map evidence on design, implementation, and effectiveness of peer provider-delivered health interventions for adolescents and youth in Eastern and Southern Africa. METHODS:We searched medical and social science databases (PubMed, Cochrane, Web of Science, EBSCOHost) for peer-reviewed literature between January 2014-May 2024. Eligible studies evaluated interventions where adolescents or youth acted as peer providers of health or wellbeing services. Data were extracted on study design, intervention characteristics, outcomes, and implementation features. 40 studies met inclusion criteria. RESULTS:Interventions primarily targeted HIV prevention and treatment, with fewer addressing connectedness and safety. Multiple wellbeing domains were associated with positive outcomes. Effective implementation included structured referral systems, integration with professional health services, participatory education, supportive supervision, and alignment with WHO quality standards. Many studies lacked theoretical frameworks, limiting understanding of impact mechanisms. CONCLUSIONS:Peer provider interventions show promise for improving adolescent health in Eastern and Southern Africa, particularly multi-component, youth-responsive interventions. Strengthening theoretical foundations and implementation research are critical for effectiveness, scalability, and sustainability.

The risk of HIV acquisition is heightened during pregnancy and early parenthood with the additional risk of vertical HIV transmission. While recent studies have improved our understanding of PrEP use among pregnant and breastfeeding women, further evidence is needed to inform the design of interventions that support sustained use, especially among young women who are pregnant or parenting. We analysed data from young women aged 15–29 years who initiated PrEP in an implementation study (FastPrEP) in Cape Town, South Africa. Logistic regression was used to examine the association between pregnancy or parenting status (≥ 1 living child) and PrEP discontinuation at 1- and 4-months post-initiation, based on pharmacy refill data. The primary exposure was currently pregnant or having a child (vs. not); secondary analyses stratified by age (15–24 vs. 25–29 years) among women who were pregnant/parenting. Models were adjusted for age and hypothesised explanatory factors were included in sensitivity analysis: service delivery location, contraceptive use, HIV risk perception, and relationship status. Between August 2022 and June 2024 n = 4,876 young women initiated PrEP; 44

Adolescent girls in Cameroon face substantial sexual and reproductive health vulnerabilities that heighten their risk of HIV exposure. Using data from 2,586 adolescent girls aged 15–19 years from the 2017–18 Cameroon Population-based HIV Impact Assessment, we examined factors associated with multiple sexual partnerships, age-disparate sex, inconsistent condom use, transactional sex, and a composite measure of high-risk sex. Overall, 4.31

Abstract Background WHO recommend that children and adolescents attend scheduled well-care visits for health promotion, prevention, early detection, identification and management of disability and disease. Children born to adolescent mothers experience a disproportionate burden of poor health outcomes, but their well-care attendance is under-researched. Methods Cross-sectional data were used from a cohort of adolescent and young mothers (10–24 years; n = 1040) and their children (n = 1145) recruited through purposive, convenience-based sampling across healthcare facilities and community-based settings in Eastern Cape, South Africa (2017–2019). Quantitative data on visit attendance up to 18 months were analysed using descriptive statistics for children of adolescent mothers (10–19 years) aged ≥ 19 months at data collection, to allow complete observation of visits. In 2022, semi-structured interviews (n = 16) were conducted until saturation, to explore factors influencing attendance. Themes were developed and matched to the capability, opportunity and motivation model of behaviour (COM-B) and Theoretical Domains Framework using a realist thematic template analysis approach. Results Records were available for 415/482 eligible children. Attendance declined from 85.1% (95%CI: 81.3–88.4) at 6 weeks to 49.7% (95%CI: 46.6–56.5%) at 18 months, with higher attendance during visits coinciding with the childhood immunisation schedule. Attendance and qualitative findings were similar by maternal HIV status. Themes were matched to the COM-B. Capability: mothers’ organisational and financial acumen facilitated their child’s attendance; mothers persisted in attending despite harsh attitudes from healthcare workers. Opportunity: financial and kinship support and information in the child health booklet facilitated visit attendance; lack of childcare support, poor weather, cost and distance to clinic interfered with attendance. Motivation: mothers were motivated to attend visits to gain knowledge and fulfil their parental role. Conclusion This study identified missed opportunities for promoting life-course health and well-being among children and their adolescent mothers, and theory-informed opportunities to support well-care visit attendance. Findings challenge deficit-based narratives highlighting mothers’ motivations and strategies for ensuring attendance. Enhancing the quality of nurse-adolescent mother interactions may increase the perceived and actual value of visits and support attendance. Further research is needed on interventions to promote consistent attendance, address barriers to access and identify opportunities to strengthen integration of well-care and HIV-related services.

The COVID-19 pandemic negatively affected sexual and reproductive health and rights (SRHR) and increased unwanted pregnancies among young people, yet scant evidence documents SRH service-access trajectories and experiences of young people living with HIV during this time. We conducted a remote study, comprised of qualitative Facebook and telephonic data collection with adolescents living with HIV and young parents in South Africa (n = 41, ages 16-29) in 2020/2021. Following this, we conducted in-depth research through calls, WhatsApp and Facebook to explore narratives of two young people living with perinatally-acquired HIV who accessed SRH services and became parents during the COVID-19 lockdowns. We engage a narrative approach to illustrate the trajectories of these two young people - documenting their biopsychosocial lives and experiences accessing SRH services - with attention to personal, structural and relational factors. Findings illustrate their agency while detailing gaps in provisions that significantly affected their health and well-being. This study applies practice theory, exploring how gendered, relational, social and geographic factors shaped young people's experiences and SRH. Despite being well-acquainted with the biomedical technologies and relationships governing their care, they struggled to navigate an altered health landscape. Findings document how they were subject to narratives of individual responsibility for their SRH amidst system-level shortcomings. Results highlight significant gaps in service provision and an imperative to enhance the material conditions for young parents living with HIV in South Africa. They underscore the need for resilient, shock-responsive health and social protection systems to maintain continuous SRH services for adolescents living with HIV during crises.

Background: Adolescence is a pivotal time for growth and autonomy, with gender norms influencing how individuals experience this developmental transition. These norms become more complex in the context of gender-based violence (GBV), which is common across adolescent girls globally. Alongside societal and gender norms, systems governing health services, social care, and governmental resource allocation also significantly shape responses to GBV. To move toward healthier norms, it is critical to better disentangle how gender norms operate, especially in the context of experiences of violence, and how these norms shape post-violence support-seeking and service provision. Objectives: We set out to explore the factors that shape support- and service-seeking, and service provision, for adolescent girls and young women who experience violence. Design: An exploratory qualitative design was used for the research. Methods: We conducted a series of community conversations in peri-urban Lusaka, Zambia in October 2022. Purposively recruited participants included adolescent girls and young women aged 15–24 ( n = 12), healthcare professionals ( n = 10), and community members ( n = 8). Community conversations combined arts-based and participatory methods with group discussions, and were conducted by an experienced Zambian female researcher over 5 days. All necessary ethical approvals were obtained and key procedures followed. Results: Participants spoke about different motivations and drivers to seek support for GBV, revealing multiple layers of support-seeking, as well as stigmatization. Emerging narratives also spoke to the norms, practices, and resources that shape service provision. In sharing personal anecdotes and perceptions of available post-violence support, participants tapped into deeper underlying norms and expectations surrounding how violence against girls and women is managed—silence, secrecy, and acceptance among them—as well as actual narratives on service provision. Conclusion: Our study’s insights, while context-specific, also speak to broader considerations for norms shifting. Harnessing safer norms across generational and sectoral divides may reduce violence and improve service access among adolescent girls and young women.

Adolescent girls and young women (AGYW) living with HIV are at increased risk of developing suicidality. Yet little is known about the effects of HIV-related stigma, mental health challenges and social support on suicidality among AGYW living with HIV. We analysed cross-sectional data from 711 AGYW living with HIV who participated in two large prospective South African cohort studies, Mzantsi Wakho (2017-2018) and HEY BABY (2018-2019). Standardised and validated questionnaires were used to measure HIV-related stigma, mental health symptomology (mediator), social support (moderator) and suicidality (outcome). A moderated mediation analysis was used to investigate (1) the direct effects of HIV-related stigma on suicidality, (2) the indirect effects as mediated through mental health symptomology and (3) the moderating effects of social support on mental health issues and suicidality, adjusted for potential confounders. Higher HIV-related stigma (β = 0.45 [0.13, 0.78], p < 0.001) was directly associated with higher suicidality. Mental health symptomology was associated with increased risk of suicidality (β = 1.05 [0.66, 1.44], p < 0.001) and partially mediated the effect of HIV-related stigma on suicidality. Social support buffered the indirect effects of HIV-related stigma on suicidality (β = 0.86, bias-corrected 95% CI [0.01, 2.41]). HIV-related stigma is associated with higher suicidality. Programmes that simultaneously address stigma and strengthen social support services may improve mental health and reduce suicidality among AGYW living with HIV.

Adolescent parenthood is a significant issue in Sub-Saharan Africa, which can have adverse effects on mothers, their children and families. South Africa faces challenges in ensuring inclusive education for adolescent girls and young women due to high dropout rates resulting in and contributing to adolescent pregnancy. While a sound policy framework for pregnant and mothering adolescents exists, implementation challenges persist, emphasising the need for effective interventions to support pregnant and mothering adolescents return to and complete their schooling. This commentary brings together quantitative data from surveys with 1046 adolescent mothers in South Africa's Eastern Cape province, coupled with participatory design incubators with young people (N = 13) in the same setting to provide implementation recommendations for policy and practice, with specific reference to the Department of Basic Education's Policy on the Prevention and Management of Learner Pregnancy in Schools. Analysing across the two data sources involved using a socio-ecological lens that acknowledges the multi-level factors and longer-term trajectories that influence adolescent mothers' schooling trajectories. Three inter-related implementation recommendations to support pregnant and mothering adolescents schooling emerge through data triangulation and analyses: (1) supportive school environment, (2) promoting peer-based support, and (3) establishing strong partnerships and referral mechanisms beyond the school setting. These recommendations are grounded in evidence, align with South Africa's existing policy framework, and speak to the expressed needs of adolescents and young people, aiming to address the complex challenges faced by pregnant and mothering adolescents. Evidence-informed interventions to support pregnant and mothering adolescents schooling can ultimately contribute to health, education, and gender equality goals. Stakeholder engagement, especially co-design engagements with pregnant and mothering adolescents, and research, monitoring and evaluation to test intervention feasibility and acceptability are essential for refining and scaling-up interventions to improve the well-being of adolescent mothers and their children.

PURPOSE:Adolescents living with HIV (ALHIV) are a priority population for achieving global HIV prevention and treatment targets but experience poorer outcomes than adults. Long-term follow-up is essential to understand their transition into adulthood. By linking self-reported survey data with routine laboratory records, we established a social science clinical cohort of ALHIV South Africa's Eastern Cape to explore factors shaping their long-term health and well-being. PARTICIPANTS:Eligible participants were adolescents who were part of a three-wave quantitative cohort of ALHIV and not living with HIV (2014-2018) and had consented (adolescent and caregiver) to having their self-reported interviews linked with routine health records (n=1563). Adolescents were recruited into the existing three-wave cohort through clinic and community-based methods (97% enrolment, >90% retention over three waves). Between 2019 and 2022, we abstracted laboratory test records from the National Health Laboratory Services database for all eligible participants, with matching based on demographic variables. Individuals with at least one HIV-related record form our 'lifelong social science cohort', a total of 956 ALHIV (852 of 1107 ALHIV and 104 of 456 HIV-uninfected). FINDINGS TO DATE:A total of 32 886 laboratory test records from 2004 to 2023 were matched through three rounds of data extraction, using iteratively refined record-linking searches. Most records were viral load (8864) and CD4 count (6801) results, with a median of 10 (IQR: 7-14) and 8 (IQR: 5-11) tests per matched adolescent, respectively. Overall, 956 of 1563 adolescents (61%) were successfully linked to laboratory data, including 852 of 1107 (77%) ALHIV. Analysis of the matched cohort survey-laboratory data provided several insights. Self-reported antiretroviral therapy adherence was strongly associated with viral suppression, even after adjusting for covariates. The strongest predictors of suppression were not reporting missed doses in the past 3 days, past week and not missing clinic appointments in the past year. Among adolescent girls and young women living with HIV, access to safe and affordable facilities, and kind and respectful staff were associated with a higher likelihood of multiple improved HIV-related outcomes, including viral suppression. Exposure to sexual and intimate partner violence predicted worse viral load outcomes among adolescents. FUTURE PLANS:This integrated prospective cohort provides an opportunity to characterise long-term HIV treatment outcomes among ALHIV in Africa. We will investigate how individual, familial, community and healthcare experiences in childhood, and adolescence shape these outcomes. Since the COVID-19 pandemic happened during the period of matched data, we will also investigate the potential effect of the COVID-19 pandemic on adolescent HIV treatment outcomes, with potential subgroup analyses for individuals with available COVID-19-related results.

Adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) are disproportionately affected by HIV. Despite the effectiveness of oral pre-exposure prophylaxis (PrEP) in preventing HIV, uptake and effective utilisation among AGYW remain suboptimal. This scoping review maps research on PrEP delivery outside clinical trials to AGYW in SSA. Quantitative and qualitative data were extracted from 58 studies on the facilitators and barriers to PrEP uptake and utilisation (including initiation, persistence, and adherence), and recommendations for effective PrEP delivery from AGYW and PrEP providers. Only studies on oral PrEP met the inclusion criteria. Facilitators of effective PrEP utilisation included social support with strong familial and peer networks positively influencing PrEP adherence and persistence. Healthcare provider interactions were pivotal in promoting PrEP uptake through dissemination of accurate information and ongoing support. Studies reported consistent barriers to PrEP uptake and utilisation including anticipated or experienced stigma, pill burden, and side effects. Addressing identified barriers and leveraging facilitators can enhance future effectiveness for PrEP delivery. There is a lack of strategies to support AGYW in long-term persistence and engagement with PrEP services. Our findings emphasise the urgent need for people-centred and localised, context-specific strategies to improve PrEP delivery among AGYW in SSA. Effective PrEP delivery strategies should include differentiated service delivery models, innovative approaches such as digital health, and integration with existing services such as antenatal care for pregnant and breastfeeding AGYW. More data is needed for PrEP delivery among AGYW across the region, including other PrEP modalities as they roll out.

The government of Kenya’s Triple Threat strategy recognises the need for urgent intervention to address the high incidence of HIV, gender-based violence (GBV) and pregnancy among adolescent girls and young women (AGYW). We used nationally representative data among AGYW aged 13–24 (n = 1344) from the 2018-19 Kenya Violence Against Children Youth Survey (VACS) in multivariable logistic regression analyses to examine associations between three potential protective factors – gender-equitable attitudes, food security and parental monitoring – and outcomes related to the triple threat: Intimate partner violence (IPV); sexual violence; high HIV exposure risk; adolescent pregnancy; child marriage; and not being in school or paid work. Results showed that AGYW with gender-equitable attitudes were less likely to report IPV (adjusted odds-ratio (aOR):0.47, p < 0.01) and adolescent pregnancy (aOR:0.58, p < 0.05). AGYW who were food secure were less likely to report adolescent pregnancy (aOR:0.57, p < 0.05) and child marriage (aOR:0.51, p < 0.05). Those with high parental monitoring were less likely to report IPV (aOR:0.44, p < 0.01), sexual violence (aOR:0.49, p < 0.05), adolescent pregnancy (aOR:0.61, p < 0.05), and child marriage (aOR:0.41, p < 0.01). AGYW who had gender-equitable attitudes, food security and high parental monitoring (i.e., all three factors compared to none) had lower predicted probabilities of reporting IPV (22.3

By 2050, one in four people in the world will live in Africa. The region's adolescents are our present and future but need effective services to support their holistic health and wellbeing, advance their education, allow them to flourish, and protect them from adversity. This paper reviews evidence for a new concept of 'development accelerators': interventions that can help achieve multiple Sustainable Development Goals simultaneously. Across 26 studies, the most frequently identified accelerators were government-provided social protection, positive parenting including good supervision of their adolescents, adolescent-friendly healthcare and childcare, positive gender norms, and psychosocial support. These have been shown to be highly cost-effective, giving substantial returns on investment, especially when applied in combination.