Title: Does School Support Reduce Risk of HIV? 3 year Evidence from a Randomized Controlled Trial among Orphan Adolescents in Kenya

Background: Over the past decades, there has been growing interest in structural interventions providing school support or subsidies, such as cash transfers, to help reduce the risk for HIV.  Orphans are particularly vulnerable to HIV risk. This study is one of very few trials testing the impact of school support on orphans’ HIV-associated risk factors and HIV and Herpes Simplex Virus Type 2 (HSV-2) infection over time.

Methods: A cluster randomized-controlled trial was conducted among orphan adolescents in western Kenya. Primary schools (N=26) were randomized to study condition. Intervention participants received financial support for school fees, uniforms and medical needs. Annual surveys were conducted in 2011 through 2014, and HIV and HSV-2 biomarkers were collected at baseline and endline. Data were analyzed using survey logistic regression or generalized estimating equations controlling for age and biological sex.

 

Results: 835 orphan adolescents participated in the study. HIV and HSV-2 prevalence was 1% and 3%, respectively, at baseline. Significant positive effects by study condition were observed over the 3 years in school dropout, school achievement, quality-adjusted life years (QALY), circumcision, depression, marriage, and other attitude variables such as educational aspirations and future expectations. Differences in HIV infection were not observed at endline.

 

Conclusions: Structural interventions providing school fees have positive impacts on important behaviors and attitudes related to HIV infection.