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Education and HIV/AIDS in Western Kenya: Results from a Randomized Trial Assessing the Long-Term Biological and Behavioral Impact of Two School-Based Interventions. Pascaline Dupas 1 , Vandana Sharma 2 , Michael Kremer 3 , Grace Makana 4 , Carolyne Nekesa 4 , Esther Duflo 2

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  1. Education and HIV/AIDS in Western Kenya: Results from a Randomized Trial Assessing the Long-Term Biological and Behavioral Impact of Two School-Based Interventions Pascaline Dupas1, Vandana Sharma2, Michael Kremer3, Grace Makana4, Carolyne Nekesa4, Esther Duflo2 1University of California Los Angeles, USA 2Massachussetts Institute of Technology, USA 3Harvard University, USA 4Innovations for Poverty Action, Busia, Kenya

  2. Background • Despite 2 decades of HIV prevention efforts, 2.5 million new HIV infections occur each year • Young people are a key group - they are often called a “window of hope” because they are uninfected and their sexual behaviors are not yet established and may be more easily molded • 45% of new infections worldwide occur in youth aged 15-24 years, with 3,000 young people infected each day

  3. Background – School Based Programs • Education has been called a “social vaccine” for HIV/AIDS • In sub-Saharan Africa most children now attend some primary schools • School-based HIV prevention programs are inexpensive, easy to implement and replicate • There is limited rigorous evidence about the effectiveness of these types of programs

  4. Background - Study design • Between 2003-2006, non-profit organization ICS implemented HIV prevention programs in 328 primary schools in Western Kenya • Schools were randomly assigned to receive none, one or both of the following interventions: • Teacher Training in Kenya’s national HIV/AIDS education curriculum • National HIV curriculum focuses on abstinence until marriage and does not include condom information • Program provided in-service training to 3 upper-primary teachers to enhance delivery of the curriculum • Uniforms Distribution Program • Provided two free uniforms for one cohort of students (girls and boys), with the aim of helping them stay in school longer (second uniform provided 18 months after first)

  5. Background - Study design • Study Location: Butere, Mumias, Bungoma South and Bungoma East districts in Western Province • Study Sample : 19,300 youths (approx half females) enrolled in Grade 6 in 2003 (~13 years) • Experimental Design:

  6. Background – Initial Follow-up • Follow-up data collected between 2003-2007 suggest that: • Teacher Training Program: • Teachers were more likely to discuss HIV in class • Had little impact on knowledge, self-reported sexual activity, or condom use. • No effect on pregnancy rates 3 years and 5 years later • Uniforms Distribution Program • Reduced dropout rates (by 17% in boys and 14% in girls) • Reduced the rate of teen childbearing • From 16% to 13% after 3 years • From 33% to 29% after 5 years

  7. Methods • A follow up study to assess the long-term biological outcomes of the two programs began in 2009 • Objective: To study the impact of the teacher training, and uniforms programs on transmission of HSV-2 • A cross-sectional survey to measure HSV-2 prevalence and behavioral outcomes was administered to subjects between February 2009 and March 2011 • Six to eight years after interventions • Note: not powered to estimate impacts on HIV

  8. Methods Random Assignment Programs offered in 2003 Follow- up in 2009-2010 KAP= Knowledge, Attitudes and Practices

  9. Results I Long term follow-up rate Effective Tracking Rate = RT survey rate + (1-RT survey Rate) x (IT survey Rate) = For 90% of sample, we have data on respondents herself/himself or on another “representative” student

  10. Results II Marriage & Childbearing 7 yrs post-intervention • Uses sampling weights (those sampled during IT have higher weight) • Controlled for age at baseline, randomization strata (school location, sex ratio and performance at baseline), date of survey/blood draw

  11. Results IIIHSV-2 infection 7 yrs post-intervention

  12. Results IVReported Sexual Behavior 7 years post-intervention

  13. Conclusions • Education subsidy (free uniforms) is effective at reducing teenage marriage and childbearing rates but not enough to reduce HSV-2 transmission • National HIV curriculum focused on abstinence until marriage seems ineffective in reducing HSV-2 transmission • Two programs implemented jointly appear to reduce HSV-2 transmission

  14. Thank you Vandana Sharma, MD, MPH Abdul LatifJameel Poverty Action Lab (J-PAL) Massachusetts Institute of Technology vsharma@povertyactionlab.org http://www.povertyactionlab.org/

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