School Support as Structural HIV Prevention for Adolescent Orphans in Western Ken

学校支持作为西肯州青少年孤儿的结构性艾滋病毒预防

• 批准号: 8139508
• 负责人: Hyunsan Cho
• 金额: $ 64万
• 依托单位: PACIFIC INSTITUTE FOR RES AND EVALUATION
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8139508
• 关键词: AIDS prevention; AIDS/HIV problem; Achievement; Acquired Immunodeficiency Syndrome; Address; Adolescent; Adult; Affect; Africa South of the Sahara; African; Age; Attitude; Biological Markers; Cause of Death; Cessation of life; Child; Clinical Trials Design; Coitus; Communities; Country; Data; Dose; Dropout; Economic Factors; Education; Effectiveness; Effectiveness of Interventions; Environmental Risk Factor; Epidemic; Ethnic group; Evaluation; Experimental Designs; Fees; Gender; HIV; HIV Infections; Human Herpesvirus 2; Individual; Infection; Intervention; Intervention Trial; Investments; Kenya; Learning; Left; Life; Link; Marriage; Mediator of activation protein; Modeling; Orphan; Outcome; Outcome Measure; Parents; Participant; Pathway interactions; Patient Self-Report; Pilot Projects; Policies; Policy Developments; Political Factor; Population; Poverty; Pregnancy; Prevalence; Prevention; Primary Schools; Process; Province; Randomized; Randomized Controlled Trials; Recruitment Activity; Research Personnel; Risk; Risk Behaviors; Sampling; School Enrollments; Schools; Seasons; Specific qualifier value; Specimen; Student Dropouts; Students; Surveys; System; Testing; Variant; Youth; Zimbabwe; base; boys; comparative; cost; cost effectiveness; delay sexual debut; design; girls; health related quality of life; high risk sexual behavior; high school; interest; pandemic disease; prevent; primary outcome; programs; psychological distress; research study; sex risk; sex trafficking; sexual debut; social; therapy development

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. PUBLIC HEALTH RELEVANCE: Although millions of children have been orphaned as a result of the AIDS pandemic, few studies have considered the particular vulnerability of young orphaned adolescents for school dropout, risky sexual behaviors, and HIV infection. The Luo people of Nyanza Province have the highest proportion of orphans, highest HIV prevalence, and earliest sexual debut among all ethnic groups in Kenya. This structural intervention trial uses a strong conceptual framework and rigorous experimental design to test whether school support can keep adolescent Luo orphans in school, reduce sexual risk behaviors, and prevent HIV /HSV-2 infection. Process evaluation and cost effectiveness analyses add further relevance for policy development.

描述（由申请人提供）：艾滋病毒/艾滋病大流行导致数百万成年人患病和过早死亡，这反过来又使撒哈拉以南非洲地区出现数百万孤儿。仅在肯尼亚，就有240多万孤儿面临辍学、过早开始性行为和感染艾滋病毒的巨大风险。在艾滋病流行的第四个十年即将到来之际，许多实地工作者呼吁在艾滋病毒预防方面进行范式转变，以解决结构性因素和个人因素。本研究探讨了学校支持的影响，作为一种结构性干预措施，在肯尼亚尼扬扎省的青少年卢奥孤儿测试。在全国所有族裔群体中，卢奥人的艾滋病毒感染率最高，孤儿感染率最高。该研究采用了严格的随机对照试验设计，以测试学校支持是否可以通过过渡到高中来留住青少年孤儿，延迟首次性行为，并降低艾滋病毒和单纯疱疹病毒2型（HSV-2）感染的可能性。本研究的具体目的是：1）实验性地检验向洛奥孤儿提供全面的学校支持是否会降低辍学率，减少危险性行为，预防HIV/HSV-2感染; 2）对该方案的实施进行过程评估;（三）进行成本效益比较分析，具体说明干预措施的成本和投资回报，如入学率主要成果的单位成本改善所证明的，延迟初次性行为和预防危险行为和HIV/HSV-2感染，以及获得与健康相关的生活质量。设计随机抽取24所小学为干预或对照条件。所有失去父母一方或双方的七年级和八年级青年，无论死因如何，都将被邀请参加;参加研究的总人数约为840名学生，每种情况420人。干预学校的青少年将获得五年的学校支持，包括学费、杂费、校服和一名以学校为基础的成人“助手”。“数据将包括年度ACASI调查、学校数据（出勤率、成绩）和HIV/HSV-2生物标本。分析将测试假定的调解人和性别适度的因果途径和程序的影响。成本效益分析将增加急需的与政策有关的信息。 公共卫生相关性：尽管数百万儿童因艾滋病而成为孤儿，但很少有研究考虑到年轻的孤儿青少年特别容易辍学、危险的性行为和艾滋病毒感染。尼扬扎省的卢奥人是肯尼亚所有族裔群体中孤儿比例最高、艾滋病毒感染率最高、初次性行为最早的群体。这项结构性干预试验使用了强有力的概念框架和严格的实验设计，以测试学校支持是否可以使青少年卢奥孤儿留在学校，减少性风险行为，并预防HIV /HSV-2感染。进程评价和成本效益分析进一步增加了政策制定的相关性。