Research on adolescent sexual and reproductive health (SRH) in sub-Saharan Africa is heavily focused on preventing unintended pregnancies and preventing HIV infection. However, very little of this work focuses on, and actively targets, boys and young men. Gender-transformative approaches, or approaches that seek to shift gender norms and power relations, have been hailed as one way to disrupt underlying factors that can lead to poor health outcomes and drive HIV infection and adolescent pregnancy. Applying a gender-transformative approach in South Africa and Lesotho, across two low-resource settings with very high rates of both HIV and adolescent pregnancy, our research aims to meet an urgent need for localised solutions and do so in an innovative and inclusive way. The aim of this study is to address the evidence gap by adapting the If I Were Jack programme for use in South Africa and Lesotho, under the name If I Were Thabo. The original programme, developed in the UK, is a group-based intervention delivered to adolescents in educational settings, which includes a culturally sensitive interactive film about an adolescent who discovers that his girlfriend is unexpectedly pregnant, and a guided discussion about how participants would feel and react in his position. The programme is accompanied by educational materials and sessions for adolescents' caregivers, and has been shown to be acceptable and cost-effective in its current form. We propose to adapt the programme in two LMICs, South Africa and Lesotho, in partnership with adolescents, parents, teachers, community members and local experts. We will target adolescents aged 13-14, an age range where there is still potential to prevent sexual risk-taking before the majority of adolescents are sexually active, and before the increase in pregnancy and STIs reported in later adolescence. To develop and test the intervention, the proposed study will involve two phases. First, we will work with adolescents, their parents and caregivers, teachers, health professionals and other key community members to adapt and optimise the programme materials from the UK for use in South Africa and Lesotho. This will involve co-producing locally relevant and appropriate intervention materials in each site. Adolescents will work with researchers and filmmakers to write, cast and develop new films in each site, and advise on the acceptability of text-based material, and their caregivers will be consulted on caregiver-targeted information. Teachers, community group facilitators and healthcare professionals will provide feedback on materials designed for programme facilitators. In addition, we will ask adolescents and their caregivers to give feedback on some of the research tools that will be used in the next phase. Next, we will run a pilot of the programme within a feasibility cluster randomised trial to assess if the intervention implementation and evaluation design is feasible in both countries. As a part of this phase we will survey adolescents in schools and community groups, half of whom will be randomly chosen to receive the intervention and the other half of whom will continue with 'normal practice'. We will assess whether the questionnaires capture the necessary information on SRH outcomes for this group, including intentions relating to adolescent pregnancy, and HIV and STI infection. We will also evaluate whether the processes needed to implement the programme work well. After programme completion, we will interview adolescents and other stakeholders about their opinions of the programme and whether it is feasible to deliver in schools and community groups, and what will hinder or help the implementation in the two settings. Based on these results, we will decide if it will be feasible to do a larger trial of the intervention in both sites to see if the programme is effective in improving SRH for adolescents in these countries.

In thirty years' time there will be half a billion adolescents in Africa. Like youth everywhere, they possess huge potential to thrive. But more than half are trapped in cycles of poor nutrition, poverty, low education, violence and unemployment. They also have the world's highest rates of early fertility, with adverse long-term outcomes for adolescent parents and their children. Such inter-generational disadvantage creates risks not only in the region but also to global stability. The SDGs and African Union's Agenda 2063 challenge us to take a radical new approach. The UK's Global Challenges Research Fund provides a unique opportunity to do this. The Accelerating Advantage Hub will find the combinations of services with the greatest positive impacts for Africa's adolescents and their children. We need to move beyond services focused on single outcomes, towards 'super-accelerator' impacts across multiple SDGs of health, education, violence prevention, gender equality and economic stability. With our government partners we will test combination services - for example of cash transfers, malaria prophylaxis, parenting programs, business skills and violence prevention - to identify the leanest and most effective policy packages. The Hub has been planned with African governments and international agencies including the UN Development Program, African Union, UNICEF and the World Health Organisation. They have told us that 'evidence as usual' is not enough. When we make a personal investment, like buying a computer, we want to know not only whether it is the most efficient, but also whether it is good value for money and whether we will like to use it. Governments need the same information about services: their effectiveness, their cost-effectiveness, whether they can be delivered through existing health, education and welfare systems, and whether they will be accepted by service providers and by adolescents. The Hub will conduct large-scale studies and use existing data in Angola, Cote D'Ivoire, DRC, Ethiopia, Gambia, Ghana, Guinea, Kenya, Lesotho, Liberia, Malawi, Mali, Mozambique, Nigeria, Senegal, Sierra Leone, South Africa, Somalia, South Sudan, Tanzania, Uganda, Zambia & Zimbabwe. All projects will include cost-effectiveness to assist budget decisions. In short, we will provide African policy-makers with the evidence they need and want to do the best for adolescents. The Hub will also train and support frontline workers to improve services for adolescents across Africa. We will turn evidence into training modules, freely accessible manuals and support materials. We will deliver practitioner training in 34 African countries by working with NGO partners selected for wide regional coverage, for example Paediatric Adolescent Treatment for Africa, the International Rescue Committee, Clowns without Borders and the International AIDS Alliance. Skills-building for young researchers in Africa and the UK is built into the Hub's work. We will support 45 promising young academics and dedicated African policymakers to focus their careers on improving the lives of adolescents and their children. The Hub's work is planned with adolescents themselves. Too many services have failed because they do not appeal to teenagers' aspirations and immediate goals. The Hub will work directly with adolescent advisory groups in Eastern, Western and Southern Africa to co-develop approaches that are not only effective, but also meaningful and fun for those who will use them. We aim to reach 20 million adolescents and their children with effective combinations of services to meet their needs. Between our direct countries of research and our NGO partners, the Hub will actively engage with policymakers, practitioners and adolescents across East, West, Southern and Central Africa and including fragile and war-torn states. We have a common goal: to transform the potential of Africa's adolescents into a thriving future for the continent.