Can Church Schools Reduce Risk of HIV Infection for Orphan Girls in Zimbabwe?

据估计，全世界有超过1600万18岁以下的儿童因艾滋病毒/艾滋病而成为孤儿;其中超过1400万儿童生活在撒哈拉以南非洲。感染艾滋病毒的风险最大的是少女孤儿和年轻妇女。本研究是一项R 01研究的2年更新，该研究于2007年由NICHD资助，以响应PA-04-0115，宗教组织和HIV。最初的研究是一项严格实施的随机对照试验，测试提供全面的学费，制服和学校“助手”是否可以减少辍学，预防艾滋病毒风险行为，并提高青少年孤儿女孩的保护态度。我们将小学随机分配到参与者在六年级时的条件，并比较他们进入高中后的结果，发现辍学和早婚的减少令人印象深刻，保护性和性别平等态度的改善。截至2011年，大多数参与者在5所卫理公会学校和5所公立学校的高中三年级。更新的具体目的如下：1）使用延迟干预对照组设计，比较综合干预组和仅收费对照组之间的假定介质和结果，增加一个额外的调查数据点，增加HIV和HSV-2生物标志物数据; 2）利用2011年津巴布韦人口和健康调查数据，形成两个外部比较组（孤儿和非孤儿农村女孩的年龄相当），检查艾滋病毒状况的差异，婚姻，学校的保留，以及DHS样本和我们的两个研究组之间的相关结果; 3）对孤儿参与者早婚的情况和影响进行定性研究，特别是使徒教会与主流教会的宗教背景的影响;和4）在E和C之间进行最新的比较成本效益分析，具体说明成本和投资回报，通过教育程度、婚姻和HIV/HSV-2感染等主要结果的单位成本改善以及健康相关生活质量的提高来证明。根据从这些具体目标中获得的信息，我们将与津巴布韦教育部和卫生部、PEPFAR官员以及全球主要捐助者合作，考虑政策影响并制定可行的扩大计划。我们的研究团队正在开发一个关于撒哈拉以南非洲孤儿青少年的独特知识库。生物标志物检测的增加，宗教对早婚影响的研究;在延迟干预C组设计中使用DHS数据进行外部比较组，成本效益研究，以及参与决策者的计划，这些都大大增强了研究的意义，创新和整体影响。 公共卫生相关性：据估计，全世界有1 600多万18岁以下儿童因艾滋病毒/艾滋病而成为孤儿;其中1 400多万儿童生活在撒哈拉以南非洲。少女孤儿和年轻妇女本身也很有可能感染艾滋病毒。这项研究将测试这样一种观点，即让孤儿少女上学可以通过推迟婚姻和过早的性行为来预防艾滋病毒和HSV-2感染。这项研究还将有助于成本效益分析，为政策提供信息。

DESCRIPTION (provided by applicant): Worldwide, it is estimated that more than 16 million children under 18 years have been orphaned by HIV/AIDS; over 14 million of these children live in sub-Saharan Africa. Among those at greatest risk of becoming HIV infected are adolescent orphan girls and young women. This study is a 2-year renewal of an R01 study, funded by NICHD in 2007 in response to PA-04-0115, Religious Organizations and HIV. The initial study was a rigorously implemented cluster randomized controlled trial, testing whether providing a comprehensive package of school fees, uniforms, and a school-based "helper" can reduce school dropout, prevent HIV risk behaviors, and increase protective attitudes among adolescent orphan girls. We randomized primary schools to condition when participants were in grade 6 and compared outcomes after they entered high school, finding impressive reductions in school dropout and early marriage, and improvements on protective sexual and gender equity attitudes. As of 2011, most participants are in their 3rd year of high school in 5 Methodist and 5 public schools. The Specific Aims for the renewal are as follows: 1) Using a delayed intervention control group design, compare posited mediators and outcomes between the comprehensive intervention group and the fees only control group for one additional survey data point, adding HIV and HSV-2 biomarker data; 2) Using the 2011 Zimbabwe Demographic and Health Survey data to form two external comparison groups (orphan and non-orphan rural girls of comparable age), examine differences in HIV status, marriage, school retention, and related outcomes between the DHS samples and our two study groups; 3) Conduct a qualitative study of the circumstances and implications of early marriage among orphan girl participants, particularly the influence of the religious context of Apostolic versus mainline churches; and 4) Conduct updated comparative cost effectiveness analyses between E and C, specifying costs and return on investment, evidenced by cost per unit improvement in primary outcomes of educational attainment, marriage, and HIV/HSV-2 infection, as well as by gains in health-related quality of life. With information gained from these specific aims, we will partner with the Zimbabwe Ministries of Education and Health, PEPFAR officials, and major global donors to consider policy implications and develop a feasible plan for scale-up. Our study team is developing a unique knowledge base about orphan teens in sub-Saharan Africa. The addition of biomarker testing, the study of religious influence on early marriage; the use of DHS data for external comparison groups in a delayed intervention C group design, the cost effectiveness study, and the plan to engage policymakers, together greatly enhance study significance, innovation, and overall impact. PUBLIC HEALTH RELEVANCE: Worldwide, it is estimated that more than 16 million children under 18 years have been orphaned by HIV/AIDS; over 14 million of these children live in sub-Saharan Africa. Adolescent orphan girls and young women are at great risk of becoming HIV infected themselves. This study will test the notion that keeping orphan adolescent girls in school can prevent HIV and HSV-2 infection by delaying marriage and early sexual behavior. The study will also contribute cost effectiveness analyses to inform policy.