Effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda: results from a non-randomized controlled trial
Effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda: results from a non-randomized controlled trial
复制标题
DOI：
10.1186/1471-2458-12-729
复制
发表时间：
2012-09-01
影响因子：
4.5
通讯作者：
Temmerman, Marleen
中科院分区：
文献类型：
--
作者：
Michielsen, Kristien;Beauclair, Roxanne;Temmerman, Marleen
背景：虽然撒哈拉以南非洲的艾滋病毒疫情正在趋于稳定，但仍处于令人无法接受的高水平。15-24岁的年轻人仍然特别容易感染艾滋病毒，导致该地区青年男子艾滋病毒流行率为1.4%，青年妇女艾滋病毒感染率为3.3%。本研究通过非随机化纵向对照试验，在卢旺达布格塞拉(干预)和卢瓦马加纳(对照)两个邻近地区选择了14所学校，评价同伴主导的预防艾滋病干预措施对青少年性行为、艾滋病知识和态度的影响。来自8所干预学校和6所对照学校的1950名学生参加了三次调查(基线、干预中的6个月和12个月)。结果：总体保留率为72%。在干预学校和对照学校的学生中，性危险行为的时间趋势(性行为活跃、最近6个月的性行为、最后一次性行为时使用避孕套)没有显著差异，干预也没有与知识的增加、感知的严重性或感知的易感性相关。结论：通过分析这项干预措施和其他干预措施，我们发现同伴教育效果有限的几个原因：1)干预活动(传播信息)不符合目标(改变行为)；2)年轻人更喜欢从其他来源获得艾滋病毒信息，而不是同伴；3)结果指标不够充分，忽视了发生性行为的关系和发生性行为的背景。通过纳入整体干预措施并重新界定同伴教育者作为宣传和转介专家和服务的联络人的作用，可以提高同伴教育的有效性。最后，我们认为，狭隘地关注性风险永远不会显著扭转局面。
Background: While the HIV epidemic is levelling off in sub-Saharan Africa, it remains at an unacceptably high level. Young people aged 15-24 years remain particularly vulnerable, resulting in a regional HIV prevalence of 1.4% in young men and 3.3% in young women. This study assesses the effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda on young people's sexual behavior, HIV knowledge and attitudes.Methods: In a non-randomized longitudinal controlled trial, fourteen schools were selected in two neighboring districts in Rwanda Bugesera (intervention) and Rwamagana (control). Students (n = 1950) in eight intervention and six control schools participated in three surveys (baseline, six and twelve months in the intervention). Analysis was done using linear and logistic regression using generalized estimation equations adjusted for propensity score.Results: The overall retention rate was 72%. Time trends in sexual risk behavior (being sexually active, sex in last six months, condom use at last sex) were not significantly different in students from intervention and control schools, nor was the intervention associated with increased knowledge, perceived severity or perceived susceptibility. It did significantly reduce reported stigma.Conclusions: Analyzing this and other interventions, we identified several reasons for the observed limited effectiveness of peer education: 1) intervention activities (spreading information) are not tuned to objectives (changing behavior); 2) young people prefer receiving HIV information from other sources than peers; 3) outcome indicators are not adequate and the context of the relationship in which sex occurs and the context in which sex occurs is ignored. Effectiveness of peer education may increase through integration in holistic interventions and redefining peer educators' role as focal points for sensitization and referral to experts and services. Finally, we argue that a narrow focus on sexual risks will never significantly turn the tide.