Process and outcome evaluation of a community intervention for orphan adolescents in western Kenya.
Process and outcome evaluation of a community intervention for orphan adolescents in western Kenya.
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DOI：
10.1007/s10900-012-9548-x
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发表时间：
2012-10
影响因子：
5.9
通讯作者：
Itindi, Janet
中科院分区：
文献类型：
--
作者：
Hallfors, Denise D.;Cho, Hyunsan;Mbai, Isabella;Milimo, Benson;Itindi, Janet
我们在肯尼亚西部农村艾滋病毒高发地区进行了一项为期2年的随机对照试验（N = 105），以测试为年轻的孤儿青少年提供校服、学费和社区访客是否能提高学校保有率并降低艾滋病毒风险因素。该试验是一项社区干预，仅限于一个社区。在本文中，我们使用纵向数据检查干预实施及其与结果的关联。我们采用定量和定性两种方法来评估以社区为基础的孤儿艾滋病预防模式，并对未来的研究提出建议。尽管1年后有希望的效果，但GEE分析显示2年后无效。志愿社区访客是干预的一个关键因素，尽管定性报告记录了积极帮助防止孤儿缺学的情况，但几乎没有显示出预期的效果。对于未来的研究，我们建议捕获过渡到高中，更大的样本量和生物标志物数据，以增加研究设计的强度。我们还建议采用以学校为基础的干预方法，以改善实施和降低基础设施成本。最后，我们建议评估护士作为提高出勤率和防止辍学的代理人，因为她们解决关键生物心理社会问题的独特能力。
We conducted a 2-year pilot randomized controlled trial (N = 105) in a high HIV-prevalence area in rural western Kenya to test whether providing young orphan adolescents with uniforms, school fees, and community visitors improves school retention and reduces HIV risk factors. The trial was a community intervention, limited to one community. In this paper, we examined intervention implementation and its association with outcomes using longitudinal data. We used both quantitative and qualitative methods to evaluate the community-based model for orphan HIV prevention, with recommendations for future studies. Despite promising effects after 1 year, GEE analyses showed null effects after 2 years. Volunteer community visitors, a key element of the intervention, showed little of the expected effect although qualitative reports documented active assistance to prevent orphans' school absence. For future research, we recommend capturing the transition to high school, a larger sample size, and biomarker data to add strength to the research design. We also recommend a school-based intervention approach to improve implementation and reduce infrastructure costs. Finally, we recommend evaluating nurses as agents for improving school attendance and preventing dropout because of their unique ability to address critical biopsychosocial problems.
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