title: Supporting adolescent orphan girls to stay in school as HIV risk prevention: evidence from a randomized controlled trial in Zimbabwe.
abstract: OBJECTIVE
  Using a randomized controlled trial in rural eastern Zimbabwe, we tested whether comprehensive support to keep orphan adolescent girls in school could reduce HIV risk.
  
  
  METHODS
  All orphan girls in grade 6 in 25 primary schools were invited to participate in the study in fall 2007 (n = 329). Primary schools were randomized to condition. All primary schools received a universal daily feeding program; intervention participants received fees, uniforms, and a school-based helper to monitor attendance and resolve problems. We conducted annual surveys and collected additional information on school dropout, marriage, and pregnancy rates. We analyzed data using generalized estimating equations over 3 time points, controlling for school and age at baseline.
  
  
  RESULTS
  The intervention reduced school dropout by 82% and marriage by 63% after 2 years. Compared with control participants, the intervention group reported greater school bonding, better future expectations, more equitable gender attitudes, and more concerns about the consequences of sex.
  
  
  CONCLUSIONS
  We found promising evidence that comprehensive school support may reduce HIV risk for orphan girls. Further study, including assessment of dose response, cost benefit, and HIV and herpes simplex virus 2 biomarker measurement, is warranted.
authors.affiliation: Pacific Institute for Research and Evaluation, 1516 E Franklin St, Suite 200, Chapel Hill, NC 27514, USA. hallfors@pire.org
authors.forename: Denise
authors.initials: D
authors.lastname: Hallfors
authors.forename: Hyunsan
authors.initials: H
authors.lastname: Cho
authors.forename: Simbarashe
authors.initials: S
authors.lastname: Rusakaniko
authors.forename: Bonita
authors.initials: B
authors.lastname: Iritani
authors.forename: John
authors.initials: J
authors.lastname: Mapfumo
authors.forename: Carolyn
authors.initials: C
authors.lastname: Halpern
mesh_terms: D000293:Adolescent; D002648:Child; D054540:Child, Orphaned / Q000523:psychology* / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D011247:Pregnancy; D012307:Risk Factors; D012423:Rural Health; D012574:Schools / Q000706:statistics & numerical data; D012944:Social Support; D015030:Zimbabwe