Peer Education Intervention to Reduce Substance Use in Southern Africa: Preliminary Findings from a Southern Africa Pilot Study

This presentation will be featured at Indonesia 2025, on the 17.09.2025.

Authors:

Tara Carney, Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council

J. Anitha Menon - University of Zambia, School of Public Health, Curtin University, School of Psychology, Dubai

Kudakwashe Madzeke - SolidarMed Zimbabwe

Beatrice Chiyokoma - SolidarMed Zambia

Gwendolyn Ciletti-Dougherty - Emory University, Rollins School of Public Health

Natalie E. Johnson - University Hospital Basel, Division of Clinical Epidemiology, Department of Clinical Research

Giuliana Sanchez - University Hospital Basel, Division of Clinical Epidemiology, Department of Clinical Research

Kim Johnson - Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council

Irene Falgas-Bague - Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Alschwil, University of Basel:

Jennifer Belus - University Hospital Basel, Division of Clinical Epidemiology, Department of Clinical Research

Abstract:

Background

Adolescents and young adults constitute a large proportion of the population in sub-Saharan Africa but face high levels of disability and mortality. This is influenced by unhealthy substance use, largely with friends, in a predominantly gender normative environment where poverty is widespread. Alternative education or vocational training programmes (VTPS) may increase chances for a promising future in a setting where youth employment is low. Key behaviours during this developmental period underpin well-being across the lifespan, including educational/ vocational attainment, developing healthy coping beyond substance use, and adoption of equitable gender norms.

Aim

To pilot test an intervention aimed at primarily reducing substance use among young people and their peer groups in underserved communities in Zambia, Zimbabwe and South Africa, and determine additional adaptions to be made to the intervention.

Methods

We conducted a single arm, pre-post pilot study of PEGISUS (Peer Education for Gender Inclusion and Substance Use in Southern Africa), an 8-session intervention. Participants and their regular substance-using peers aged 16 to 24 were recruited from underserved communities, and existing staff at VTPs delivered PEGISUS. Lifetime substance use, and frequency of use in the past 3 months was evaluated using the Alcohol, Smoking, and Substance Involvement Screening Test tool developed by the World Health Organization. We calculated lifetime substance use prevalence before receiving PEGISUS, and changes in frequency pre- and post-intervention using chi-square tests of association.

Results

Total sample size was 57 participants across 18 peer groups. The three most prevalent lifetime substances reported were alcohol (n=57%, n=100), cannabis (n=43, 75%) and tobacco (n=37, 35%). Twenty-two percent (n=13) also reported lifetime opioid use. At post-test, a significant decrease in alcohol mean score (p=0.001) and frequency (p=0.02) was found. While PEGISUS was well-received, workshop sessions that introduced concepts of gender were least understood by interventionists and participants.

Discussion

Results showed that substance use is prevalent among adolescent peer groups, and that preliminary data that PEGISUS can reduce alcohol frequency is promising.

Findings from the pilot study will be used to make final adaptations to the intervention and associated training materials before the larger randomized control trial begins within VTPs.