HIV/AIDS Orphaned and Vulnerable Children Public Health Evaluation
Condition: Adolescent Behavior; Risk Reduction Behavior; Stress, Psychological
MeSH terms: Stress, Psychological
Study type: Interventional

Summary: 
      The PHE study is a two-year longitudinal study evaluating two interventions for reducing
      depression and HIV risk behaviors among highly vulnerable adolescents in the Eastern Cape of
      South Africa. Research suggests that children affected by AIDS are at heightened risk of HIV
      infection relative to their peers; however, evidence on how best to address HIV prevention
      and psychological health among this population is lacking. This study examines the efficacy
      of both a psychological and behavioral intervention, alone and in combination, on related
      outcomes among vulnerable youth age 14-17. A mixed methods approach is applied, including a
      community-randomized controlled trial with a factorial design, a cost-effectiveness analysis,
      and a qualitative component. At baseline data collection in January 2012, more than 1000
      adolescents and their caregivers were interviewed; these participants were invited to take
      part in two more survey rounds designed to examine both the immediate and long term effects
      of the interventions. Support for this research was provided by USAID under Grant No.
      GHH-I-00-007-00069-00.
    

Detailed description: 
      The study will apply a mixed-methods approach involving two primary components: 1) an impact
      evaluation using a community-randomized controlled trial (CRCT); and 2) a detailed analysis
      of intervention costs, linked to the impact evaluation to determine the cost-effectiveness of
      these interventions.

      For the CRCT, sixty World Vision drop-in centers which deliver standard care were randomly
      assigned to one of four study conditions: IPTG, Vhutshilo, IPTG+Vhutshilo, and control.
      Approximately 1600 adolescent OVC aged 14-17 years (current beneficiaries at the drop-in
      centers) and their caregivers were eligible to participate in the study at baseline.

      Participants were visited three times including the baseline survey. Follow-up data
      collection was conducted in two rounds. The first round took place 8 months after the
      baseline survey and immediately following intervention exposure. A second follow-up round
      took place a year later, allowing assessment of both the immediate and longer-term impact of
      the interventions.

      Participants were interviewed at home in Xhosa or Sesotho. Caregivers in the sample completed
      face-to-face interviews with trained interviewers, while adolescents complete surveys used a
      mix of face-to-face interviewing and audio computer-assisted self-interview technology
      (ACASI).
    

Intervention name(s): Interpersonal Psychotherapy for Groups (IPTG); Vhutshilo 2
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Interpersonal psychotherapy is a theory- and evidence-based treatment approach for depression developed by clinicians. World Vision has helped to pioneer the use of this model in sub-Saharan Africa including adapting the model for use with OVC within South Africa. Sessions are designed to provide participants with opportunities to learn and practice interpersonal skills for solving problems that bring about depression, and to facilitate the provision of emotional support between members of the group. Groups are implemented by a trained adult facilitator from the community who helps participants to identify people who are important in their lives, understand links between their psychological state and current problems, and practice new ways of problem-solving.; The Vhutshilo 2 model was developed in 2008 by the Centre for the Support of Peer Education (CSPE), a branch of the South African non-profit organization Health and Education Training and Technical Assistance Services. The Vhutshilo program was designed specifically for adolescent OVC in South Africa, and attends to risk factors and pathways considered particularly relevant for this population. Topics include finding and giving emotional support; dealing with grief and loss; alcohol and substance abuse; crime and sexual violence; HIV/AIDS; healthy and safe sexual relationships; and transactional sex. In addition to its knowledge component, the program places heavy emphasis on building relevant skills and efficacy.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Orphans and vulnerable children (OVC); Program Evaluation; HIV Prevention; Psychosocial Wellbeing; Adolescents