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

教会学校能否降低津巴布韦孤女感染艾滋病毒的风险？

• 批准号: 8339863
• 负责人: DENISE Dion HALLFORS
• 金额: $ 54.43万
• 依托单位: PACIFIC INSTITUTE FOR RES AND EVALUATION
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-27 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8339863
• 关键词: AIDS/HIV problem; Adolescent; Africa South of the Sahara; African; Age; American; Attention; Attitude; Biological Markers; Child; Childbirth; Church; Control Groups; Data; Demographic and Health Surveys; Drops; Economics; Fees; Female Adolescents; Focus Groups; Funding; Gender; HIV; HIV Infections; Health; Health education; Human Herpesvirus 2; Infection; International; Intervention; Investments; Journals; Life; Maps; Marriage; Mediator of activation protein; Methodist Church; Methods; National Institute of Child Health and Human Development; Orphan; Outcome; Outcome Measure; Paper; Parents; Participant; Patient Self-Report; Policies; Primary Schools; Public Health; Publications; Publishing; Randomized; Randomized Controlled Trials; Religion and Spirituality; Reporting; Research; Research Personnel; Risk; Risk Behaviors; Rural; Sampling; Schools; Seasons; Sex Behavior; Specific qualifier value; Student Dropouts; Surveys; Teenagers; Testing; Update; Zimbabwe; base; comparative; comparison group; cost; cost effectiveness; design; girls; group intervention; health related quality of life; high school; innovation; intervention effect; knowledge base; policy implication; population based; prevent; primary outcome; response; scale up; social; young woman

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.

描述（由申请人提供）：据估计，全世界有超过 1600 万 18 岁以下儿童因艾滋病毒/艾滋病而成为孤儿；其中超过 1,400 万儿童生活在撒哈拉以南非洲地区。感染艾滋病毒的风险最大的是青少年孤女和年轻妇女。这项研究是 R01 研究的两年更新，该研究由 NICHD 于 2007 年资助，以响应 PA-04-0115、宗教组织和艾滋病毒。最初的研究是一项严格实施的整群随机对照试验，测试提供一整套包括学费、校服和校内“帮手”是否可以减少辍学率、预防艾滋病毒危险行为并提高青少年孤女的保护态度。我们对小学进行了随机分组，以参与者在六年级时为条件，并比较了他们进入高中后的结果，发现辍学和早婚现象显着减少，保护性和性别平等态度也有所改善。截至 2011 年，大多数参与者都在 5 所卫理公会学校和 5 所公立学校就读高中三年级。更新的具体目标如下： 1) 使用延迟干预对照组设计，比较综合干预组和仅收费对照组之间的假定中介因素和结果，以获得一个额外的调查数据点，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（年龄相当的农村孤儿和非孤儿女孩），检查国土安全部样本与我们的样本之间在艾滋病毒状况、婚姻、学校保留率和相关结果方面的差异。两个学习小组； 3) 对孤女参与者中早婚的情况和影响进行定性研究，特别是使徒教会与主流教会的宗教背景的影响； 4) 在 E 和 C 之间进行更新的比较成本效益分析，具体说明成本和投资回报，以教育程度、婚姻和 HIV/HSV-2 感染等主要结果的单位改善成本以及在与健康相关的生活质量。根据从这些具体目标中获得的信息，我们将与津巴布韦教育部和卫生部、PEPFAR 官员和全球主要捐助者合作，考虑政策影响并制定可行的扩大规模计划。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。增加生物标志物测试，研究宗教对早婚的影响；在延迟干预 C 组设计中使用 DHS 数据作为外部比较组、成本效益研究以及政策制定者参与的计划，共同大大增强了研究的意义、创新性和整体影响。

项目成果

'I thought if I marry the prophet I would not die': The significance of religious affiliation on marriage, HIV testing, and reproductive health practices among young married women in Zimbabwe.

• DOI: 10.1080/17290376.2016.1245627
• 发表时间: 2016-12
• 期刊: SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance
• 作者: Hallfors DD;Iritani BJ;Zhang L;Hartman S;Luseno WK;Mpofu E;Rusakaniko S
• 通讯作者: Rusakaniko S

Preventing HIV by providing support for orphan girls to stay in school: does religion matter?

• DOI: 10.1080/13557858.2012.694068
• 发表时间: 2013-02-01
• 期刊: ETHNICITY & HEALTH
• 影响因子: 3.1
• 作者: Hallfors, Denise D.;Cho, Hyunsan;January, James
• 通讯作者: January, James

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

• DOI: 10.1080/07399332.2015.1017641
• 发表时间: 2016
• 期刊: Health care for women international
• 影响因子: 1.4
• 作者: Iritani BJ;Cho H;Rusakaniko S;Mapfumo J;Hartman S;Hallfors DD
• 通讯作者: Hallfors DD

Cost-effectiveness of school support for orphan girls to prevent HIV infection in Zimbabwe.

• DOI: 10.1007/s11121-012-0315-0
• 发表时间: 2013-10
• 期刊: PREVENTION SCIENCE
• 影响因子: 3.5
• 作者: Miller, Ted;Hallfors, Denise;Cho, Hyunsan;Luseno, Winnie;Waehrer, Geetha
• 通讯作者: Waehrer, Geetha

Marital Age Disparity Among Orphaned Young Women and Their Husbands: A Mixed Methods Study in Rural Zimbabwe.

年轻孤儿妇女及其丈夫的婚姻年龄差异：津巴布韦农村地区的混合方法研究。

• DOI: 10.1007/s10935-016-0444-5
• 发表时间: 2016
• 期刊: The journal of primary prevention
• 作者: Zhang,Lei;Iritani,BonitaJ;Luseno,Winnie;Hartman,Shane;Rusakaniko,Simbarashe;Hallfors,DeniseDion
• 通讯作者: Hallfors,DeniseDion