School Support as Structural HIV Prevention for Adolescent Orphans in Kenya

描述(申请人提供)：艾滋病毒/艾滋病的流行已导致数百万成年人患病和过早死亡，这反过来又在撒哈拉以南非洲留下了数百万孤儿。仅在肯尼亚，就有240多万孤儿面临着辍学、早熟和感染艾滋病毒的巨大风险。在接近艾滋病流行的第四个十年之际，该领域的许多人呼吁改变艾滋病毒预防的模式，以解决结构性和个人层面的因素。这项研究考察了学校支持作为一种结构性干预的影响，并在肯尼亚尼安扎省的罗奥孤儿中进行了测试。在全国各民族中，罗族是艾滋病毒感染率最高的民族，孤儿流行率最高。这项研究使用严格的随机对照试验设计来测试学校支持是否可以让青少年孤儿在高中过渡期间留在学校，推迟首次性行为，并降低感染艾滋病毒和单纯疱疹病毒2型(HSV-2)的可能性。这项研究的具体目的是：1)通过实验测试为罗籍孤儿男女儿童提供全面的学校支持是否将减少辍学、减少性行为和预防HIV/HSV-2感染；2)对计划的实施进行过程评估；以及3)进行比较成本效益分析，以确定干预措施的成本和投资回报，其证据是学校入学主要结果的单位成本改善、首次性行为延迟和危险行为和HIV/HSV-2感染的预防，以及与健康相关的生活质量的提高。该设计将24所小学随机分为干预和对照两组。所有失去父母一方或双亲的7年级和8年级的青少年，无论死因如何，都将被邀请参加；研究招募的总人数约为840名学生，每种情况下420名。干预学校的青少年将获得五年的学校支持，包括学杂费、校服和一名校本成人帮手。数据将包括ACASI年度调查、学校数据(出勤率、成绩)和艾滋病毒/单纯疱疹病毒2型生物样本。分析将测试假定的中介变量和性别调节在因果路径和计划效果中的作用。成本效益分析将增加急需的与政策相关的信息。

DESCRIPTION (provided by applicant): The HIV/AIDS pandemic has led to illness and early death for millions of adults, and this, in turn, has left many millions of orphans in sub-Saharan Africa. In Kenya, alone, there are more than 2.4 million orphans who are at great risk for school dropout, early sexual debut, and HIV infection. Approaching the fourth decade of the AIDS epidemic, many in the field have called for a paradigm shift in HIV prevention, to address structural, as well as individual-level, factors. This study examines the impact of school support as a structural intervention, tested among adolescent Luo orphans in Nyanza Province, Kenya. The Luos have the highest HIV prevalence and largest orphan prevalence of all ethnic groups in the country. The study uses a rigorous randomized controlled trial design to test whether school support can retain adolescent orphans in school through the transition to high school, delay sexual debut, and reduce the likelihood of HIV and herpes simplex virus type 2 (HSV-2) infections. Specific aims for the proposed study are: 1) To experimentally test whether providing comprehensive school support to Luo orphaned boys and girls will reduce school dropout, reduce sexual risk behaviors, and prevent HIV/HSV-2 infection; 2) To conduct a process evaluation of the implementation of the program; and 3) To conduct comparative cost effectiveness analyses, specifying the intervention's cost and return on investment as evidenced by cost per unit improvement in the primary outcomes of school enrollment, delay of sexual debut and prevention of risk behaviors and HIV/HSV-2 infection, as well as by gains in health- related quality of life. The design randomizes 24 primary schools to intervention or control condition. All youth in grades 7 and 8 who have lost one or both parents, regardless of cause of death, will be invited to participate; the total number of participants to be recruited into the study is approximately 840 students, 420 in each condition. Youth in intervention schools will receive five years of school support, including tuition, fees, uniforms, and a school-based adult "helper." Data will comprise annual ACASI surveys, school data (attendance, grades), and HIV/HSV-2 bio-specimens. Analyses will test posited mediators and gender moderation in causal pathways and program effects. Cost effectiveness analyses will add much needed policy-relevant information.