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

描述(申请人提供)：在世界范围内，估计有1600多万18岁以下儿童因艾滋病毒/艾滋病而成为孤儿；其中1400多万儿童生活在撒哈拉以南非洲。在感染艾滋病毒风险最大的人群中，有少女、孤儿和年轻妇女。这项研究是2007年NICHD为应对PA-04-0115、宗教组织和艾滋病毒而资助的R01研究的两年续展。最初的研究是一项严格执行的整群随机对照试验，测试提供全面的一揽子学费、校服和学校帮手是否可以减少辍学，防止艾滋病毒危险行为，并提高青少年孤儿女孩的保护态度。我们将参与者在六年级时的状况随机分配到小学，并比较了他们进入高中后的结果，发现辍学和早婚的情况显著减少，保护性态度和性别平等态度有所改善。截至2011年，大多数参与者是5所卫理公会学校和5所公立学校的高三学生。更新的具体目的如下：1)使用延迟干预控制组设计，比较综合干预组和仅收费对照组之间的假设介体和结果，增加一个调查数据点，添加HIV和HSV-2生物标志物数据；2)使用2011年津巴布韦人口和健康调查数据形成两个外部比较组(年龄相当的孤儿和非孤儿农村女孩)，检查国土安全部样本和我们两个研究组在艾滋病毒状况、婚姻、在校时间和相关结果方面的差异；3)对孤儿女孩参与者早婚的情况和影响进行定性研究，特别是使徒教会和主流教会的宗教背景的影响；4)对E和C进行最新的成本效益比较分析，具体说明成本和投资回报，证据是教育程度、婚姻和艾滋病毒/单纯疱疹病毒感染的基本结果的单位成本改善，以及与健康有关的生活质量的提高。根据从这些具体目标获得的信息，我们将与津巴布韦教育部和卫生部、PEPFAR官员和主要的全球捐助者合作，考虑政策影响并制定可行的扩大规模的计划。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。增加生物标记物测试，研究宗教对早婚的影响；在延迟干预C组设计中使用国土安全部外部比较组的数据，成本效益研究，以及让政策制定者参与的计划，这些都大大提高了研究的意义、创新性和整体影响。

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.