Keeping Adolescent Orphans in School to Prevent Human Immunodeficiency Virus Infection: Evidence From a Randomized Controlled Trial in Kenya

Abstract

Purpose-We report findings from a pilot study in western Kenya, using an experimental design to test whether comprehensive support to keep adolescent orphans in school can reduce HIV risk factors.Methods-Adolescent orphans age 12-14 years (N=105) in Nyanza Province were randomized to condition, after stratifying by household, gender, and baseline survey report of sexual behavior. The intervention comprised school fees, uniforms, and a "community visitor" who monitored school attendance and helped to resolve problems that would lead to absence or dropout. Data were analyzed using Generalized Estimating Equations over two time points, controlling for gender and age.Results-Compared with controls, intervention students were less likely to drop out of school, commence sexual intercourse, or report attitudes supporting early sex. School support also increased pro-social bonding and gender equity attitudes.Conclusions-After one year of exposure to the intervention, we found evidence suggesting that comprehensive school support can prevent school dropout, delay sexual debut, and reduce HIV risk factors. More research, with much larger samples, is needed to better understand factors that mediate the association between educational support and delayed sexual debut, and how gender might moderate these relationships.

Educational Outcomes for Orphan Girls in Rural Zimbabwe: Effects of a School Support Intervention

“…The findings extend those of a published report of reduced school dropout after two years of comprehensive school support (Hallfors et al, 2011) and are congruent with other findings of schooling subsidies helping SSA adolescents stay in school at one- and two-year follow-up (Baird et al, 2011; Cho et al, 2011). The comprehensive intervention is associated with reduced frequency of both delayed school progression and permanent dropout 2, 3, and 5 years after study onset.…”

“…Evans et al (2009) found that uniform provision improved average test score one year after program inception, but not beyond. Cho et al (2011) found that orphan school support reduced drop out after one year. None of these researchers examined normal progression (advancing in grade each year) and only two (Baird et al, 2011; Evans et al, 2009) examined performance (e.g., test scores).…”

Discordance of HIV and HSV-2 biomarkers and self-reported sexual behaviour among orphan adolescents in Western Kenya

“…We conducted the baseline survey using ACASI on personal digital assistant (PDA) devices. The self-administered questionnaire was originally developed from several validated instruments and has been used in a previous pilot study in Kenya24 as well as a similar Zimbabwean study 25. We added several items from the Kenya Demographic and Health Survey (KDHS) 22.…”

A conceptual framework for early adolescence: a platform for research

“…For example, a randomized controlled trial conducted in Kenya implemented an intervention for comprehensive educational support (i.e., school fees, uniforms, community visitor to monitor attendance, etc.) among orphans, and monitored their school attendance and health behaviors over time (65). The researchers found that providing comprehensive educational support not only lowered school absenteeism and dropout but it also had promise to delay sexual initiation and other risk factors associated with HIV.…”