title: Process and outcome evaluation of a community intervention for orphan adolescents in western Kenya.
abstract: We conducted a 2-year pilot randomized controlled trial (N = 105) in a high HIV-prevalence area in rural western Kenya to test whether providing young orphan adolescents with uniforms, school fees, and community visitors improves school retention and reduces HIV risk factors. The trial was a community intervention, limited to one community. In this paper, we examined intervention implementation and its association with outcomes using longitudinal data. We used both quantitative and qualitative methods to evaluate the community-based model for orphan HIV prevention, with recommendations for future studies. Despite promising effects after 1 year, GEE analyses showed null effects after 2 years. Volunteer community visitors, a key element of the intervention, showed little of the expected effect although qualitative reports documented active assistance to prevent orphans' school absence. For future research, we recommend capturing the transition to high school, a larger sample size, and biomarker data to add strength to the research design. We also recommend a school-based intervention approach to improve implementation and reduce infrastructure costs. Finally, we recommend evaluating nurses as agents for improving school attendance and preventing dropout because of their unique ability to address critical biopsychosocial problems.
authors.affiliation: Pacific Institute for Research and Evaluation, 1516 E. Franklin St., Suite 200, Chapel Hill, NC 27154, USA. Hallfors@pire.org
authors.forename: Denise D
authors.initials: DD
authors.lastname: Hallfors
authors.forename: Hyunsan
authors.initials: H
authors.lastname: Cho
authors.forename: Isabella
authors.initials: I
authors.lastname: Mbai
authors.forename: Benson
authors.initials: B
authors.lastname: Milimo
authors.forename: Janet
authors.initials: J
authors.lastname: Itindi
mesh_terms: D000293:Adolescent; D054540:Child, Orphaned; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D036301:Qualitative Research; D012307:Risk Factors; D012424:Rural Population; D012574:Schools / Q000191:economics*; D013332:Student Dropouts / Q000706:statistics & numerical data