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

Abstract

Despite a strong study design, we found no relative reduction in HIV or HSV-2 infection after 3 years of intervention implementation. New incidence of HIV was lower than expected in this region among youth whose average age at end line was 18 years (range = 14-23). Although support for secondary school promises many benefits for vulnerable youth, our study adds to the growing body of research showing weak evidence for its effectiveness as an HIV prevention.

Process Evaluation of a Clinical Trial to Test School Support as HIV Prevention Among Orphaned Adolescents in Western Kenya

“…If adolescents who drop out of school are at higher risk of sexually transmitted infection than non-dropouts, then fewer terms in school should have resulted in higher HIV/HSV-2 infection. Moreover, in RCT analyses, the intervention decreased the odds of school dropout, but failed to reduce the odds of sexual risk behaviors, such as early sexual debut, marriage, or pregnancy, and it did not increase condom use (Cho et al, 2017). The intervention did, however, decrease the odds of transactional sex (odds ratio=.47; p=.03), but the number reporting this behavior was low (about 8% of the full study sample).…”

“…The intervention did, however, decrease the odds of transactional sex (odds ratio=.47; p=.03), but the number reporting this behavior was low (about 8% of the full study sample). It also increased the odds of male circumcision (odds ratio=1.66; p=.04) (Cho et al, 2017), which may eventually have an impact on HIV prevention.…”

“…We used several validated instruments to compose the survey, which was implemented both in Kenya and Zimbabwe studies (Cho et al, 2015; Hallfors et al, 2011; Hallfors et al, 2015). At baseline (2011) and the final follow up (2014), we collected biological samples for HIV and HSV-2 testing (Cho et al, 2017; Luseno, Hallfors, et al, 2014), and here use manufacturer thresholds for HSV-2 infection.…”

“…Most have resulted in improved school enrollment and attendance for intervention group participants compared to controls, and lowered various HIV risk factors. But none have found main effect changes in HIV or HSV-2 (genital herpes) biological markers (Cho, Mbai, Luseno, Hobbs, Halpern, & Hallfors, 2017; Duflo, Dupas, & Kremer, 2015; Hallfors et al, 2015; Pettifor et al, 2016), although one study (Baird, Garfein, McIntosh, & Ozler, 2012) reported a significant effect on HIV biomarkers among girls enrolled in school at baseline. That cluster randomized trial provided a combination of modest conditional cash payments and high school tuition for young women (ages 13–22), most of whom were in school at baseline (Baird et al, 2012).…”

“…We also expected improved health-related quality of life, due to the economic value of school support, the visits from the nurses, and the positive mental health effects of being in school and avoiding risk behaviors. The only behavioral HIV-related benefits found, however, were increased male circumcision and reduced transactional sex (Cho et al, 2017). We also found some quality of life differences between the two conditions, with the intervention group less likely to report problems with anxiety and depression and the ability to perform usual activities, but no group difference on the full 5-item quality of life scale (Jelsma, Hansen, De Weerdt, De Cock, & Kind, 2003).…”