The Pacific Institute for Research and Evaluation, Chapel Hill, North Carolina.
School of Nursing, Moi University, Eldoret, Kenya.
J Adolesc Health. 2018 Jan;62(1):44-51. doi: 10.1016/j.jadohealth.2017.07.015. Epub 2017 Nov 6.
Using a clustered randomized controlled trial design, we evaluated whether support to keep Kenyan orphaned adolescents in school reduces the risk of HIV infection.
Participants included 835 orphaned boys and girls in grades 7 and 8 (mean age at the baseline = 15 years) in western Kenya. Primary schools (N = 26) were randomized to the study condition. Intervention participants received school uniforms, payment of tuition when they transitioned into high school, and nurse visits to monitor school absenteeism and provide assistance to stay in school. Annual surveys were conducted from 2011 through 2014, and HIV and herpes simplex virus 2 (HSV-2) biomarker data were collected at the baseline and the end line. Data were analyzed using survey logistic regression or generalized estimating equations controlling for age, gender, and socioeconomic status.
Intervention and control groups were equivalent at the baseline and did not differ on new HIV or HSV-2 incidence at the end line. The school support intervention increased school retention but had few HIV-related effects, except increased circumcision among male participants and reduced likelihood of transactional sex.
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.
采用整群随机对照试验设计，我们评估了对肯尼亚孤儿青少年提供支持使其继续留在学校是否能降低感染艾滋病病毒的风险。
参与者包括肯尼亚西部 7 年级和 8 年级的 835 名孤儿男童和女童（基线时的平均年龄为 15 岁）。小学（N=26）被随机分配到研究组。干预组参与者获得校服、升读高中时支付学费，以及护士上门访视以监测缺课情况并提供帮助以继续留校。从 2011 年到 2014 年进行了年度调查，并在基线和终点线收集了艾滋病病毒和单纯疱疹病毒 2（HSV-2）生物标志物数据。数据分析采用了调查逻辑回归或广义估计方程，控制了年龄、性别和社会经济地位等因素。
干预组和对照组在基线时相当，在终点线时也没有在新的艾滋病病毒或 HSV-2 发病率上存在差异。学校支持干预措施提高了学校的保留率，但对艾滋病病毒相关结果影响有限，除了增加了男性参与者的割礼比例，降低了易发生性行为的可能性。
尽管研究设计很强，但我们发现，在实施 3 年干预措施后，艾滋病病毒或 HSV-2 感染率并没有相对降低。在该地区，青年的新艾滋病病毒感染率低于预期，他们的平均年龄在终点线为 18 岁（范围 14-23 岁）。虽然支持中学教育为弱势青年带来了许多好处，但我们的研究增加了越来越多的研究结果，表明其作为艾滋病预防措施的效果证据薄弱。
