Engaging adolescent girls and young women in HIV prevention: A retrospective, observational outcome evaluation of the Eyakho Mo’ghel digital rewards programme in South Africa

Abstract

Abstract Introduction Adolescent girls and young women (AGYW) in South Africa face disproportionately high HIV incidence, yet uptake and retention in prevention services remain suboptimal. Behavioural economics approaches, including incentive-based models, have shown promise in improving health-seeking behaviours among this population. This study evaluated the Eyakho Mo’ghel (EM) programme, a membership-based digital rewards initiative implemented by Shout-It-Now within the DREAMS HIV prevention framework, to assess its impact on HIV prevention and sexual and reproductive health (SRH) service engagement among AGYW. Methods A retrospective, observational outcome evaluation was conducted across the full programme implementation period (December 2021–February 2025) in five districts in Gauteng and North West provinces, South Africa. Deidentified clinical and app records for 4,684 EM members were analysed alongside a 1:1 matched comparison group of 4,684 non-members drawn from approximately one million records using stratified random sampling. Outcomes included HIV testing, pre-exposure prophylaxis (PrEP) uptake and persistence, contraceptive use, gender-based violence (GBV) disclosure, and key health indicators. Multivariable logistic and Poisson regression models, adjusted for age and district, were used to examine associations between EM membership, app usage patterns, and outcomes. Results EM members were over three times more likely to have tested for HIV (OR = 3.16, 95% CI: 2.83–3.54) and tested significantly more frequently than non-members. PrEP initiation was also markedly higher among EM members (OR = 3.15, 95% CI: 2.85–3.48), and persistence beyond the first dispensation was approximately 67% more likely (OR = 1.67, 95% CI: 1.63–1.72). Contraceptive uptake was 75% more likely (OR = 1.75, 95% CI: 1.53–2.01), and EM members were 54% more likely to disclose GBV experiences (OR = 1.54, 95% CI: 1.24–1.91). Sustained app engagement and cumulative point accumulation were consistently associated with improved outcomes. No significant differences in HIV seroconversion, TB screening, or incident pregnancy were observed. Conclusions A non-monetary, digitally integrated rewards programme was associated with meaningful improvements in HIV prevention service uptake, PrEP persistence, contraceptive use, and GBV disclosure among AGYW. These findings support the integration of incentive-based digital engagement models within combination HIV prevention frameworks, particularly in resource-constrained settings.