Effectiveness of a digital, school-based, intervention in adolescent family planning and reproductive health in Rwanda: a cluster randomized implementation trial

We conducted a cluster randomized hybrid Effectiveness-Implementation study of CyberRwanda, a digital family planning and reproductive health intervention for Rwandan adolescents. Sixty schools were randomized 1:1:1 to control or to one of two implementation models: self-service (self-guided access on tablets) or facilitated (peer-led clubs plus tablet access) with no masking. Eligible participants were aged 12–19 years, in secondary school levels 1 or 2, and willing to provide consent or assent/parental consent and contact information for follow-up. In 2021, 6,078 randomly selected adolescents were enrolled. At 24 months, 91.3% of participants were retained and included in the primary intention-to-treat analyses (control: n=1,845; self-service: n=1,849; facilitated: n=1,858). There were no adverse events related to the study. CyberRwanda did not affect the primary outcomes of modern contraceptive use (prevalence ratio [PR]: 1.04; 95% confidence interval [CI]: 0.76, 1.42), childbearing (PR: 1.33; 95% CI: 0.71, 2.50), and HIV testing (PR: 1.00; 95% CI: 0.91, 1.11) in the full sample. Significantly higher modern contraceptive use observed in the CyberRwanda facilitated arm in a pre-specified analysis of sexually active participants suggests that longer-term evaluation is needed to examine effects as more of the study population becomes sexually active and has increased demand for contraception. ClinicalTrials.gov registration: NCT04198272.