Abstract
Orphaned adolescents are a large and vulnerable population in sub-Saharan Africa, at higher risk for HIV than non-orphans. Yet prevention of new infection is critical for adolescents since they are less likely than adults to enter and remain in treatment and are the only age group with rising AIDS death rates. We report process evaluation for a randomized controlled trial (RCT) testing support to stay in school (tuition, uniform, nurse visits) as an HIV prevention strategy for orphaned Kenyan adolescents. The RCT found no intervention effect on HIV/HSV-2 biomarker outcomes. With process evaluation, we examined the extent to which intervention elements were implemented as intended among the intervention group (N = 412) over the 3-year study period (2012–2014), the implementation effects on school enrollment (0–9 terms), and whether more time in school impacted HIV/HSV-2. All analyses examined differences as a whole, and by gender. Findings indicate that school fees and uniforms were fully implemented in 94 and 96% of cases, respectively. On average, participants received 79% of the required nurse visits. Although better implementation of nurse visits predicted more terms in school, a number of terms did not predict the likelihood of HIV/HSV-2 infection. Attending boarding school also increased number of school terms, but reduced the odds of infection for boys only. Four previous RCTs have been conducted in sub-Saharan Africa, and only one found limited evidence of school impact on adolescent HIV/HSV-2 infection. Our findings add further indication that the association between school support and HIV/HSV-2 prevention appears to be weak or under-specified.
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Acknowledgements
Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH092215 (Hyunsan Cho, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors wish to express their sincere appreciation to Marcia Hobbs and the staff of the Kenya National HIV Reference Laboratory for their invaluable help with biomarker data collection and analysis and to John Mark Wanyama for his many contributions to the study and for answering our questions about data for the manuscript.
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Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH092215 (Hyunsan Cho, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Hallfors, D.D., Cho, H., Hartman, S. et al. Process Evaluation of a Clinical Trial to Test School Support as HIV Prevention Among Orphaned Adolescents in Western Kenya. Prev Sci 18, 955–963 (2017). https://doi.org/10.1007/s11121-017-0827-8
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DOI: https://doi.org/10.1007/s11121-017-0827-8