The major goal of this research is to develop, implement, and assess the effectiveness of Hope for the Future, an innovative intervention specifically tailored for adolescents attending rural community secondary schools in Malawi -- a country with one of the highest HIV prevalence rates in the world. Based on an integration of 3 theories (Social Cognitive Behavior Theory, The Theory of Possible Selves, and Resilience Theory) and findings from the PI's dissertation, the intervention is designed to give Malawi adolescents the hope and confidence that through their own acts they can avoid contracting HIV or live a long and productive life if already infected. The intervention will be delivered in seven 2-hour sessions after school to mixed-gender groups consisting of 16 students (8 male and 8 female). The study design consists of 4 phases. Phase I (Aim 1) will survey and in-depth interview male youth ages 15 to 17 about sexual decision-making and their knowledge, attitudes, and behavior relevant to HIV AIDS. These data will be analyzed and compared with matching findings for girls from the PI's dissertation research conducted at the same 7 schools in Malawi's Lilongwe Rural West District. Phase II (Aim 2) will develop a working draft of the intervention's curricula and facilitators' manual prior to pre-testing for feasibility and acceptability. A Community Advisory Group, the PI's mentors, and six focus groups of youth will critique the program's intervention sessions and learning modules to assure that they are culturally sensitive, developmentally appropriate, and relevant for secondary school adolescents. In Phase III (Aim 3) the revised intervention will be pilot tested at 2 community secondary day schools. Process evaluation will assess fidelity to the intervention's protocols. A semi-structured questionnaire will be developed, pre- tested, and used with the groups at base-line and 2 months post-intervention to assess program feasibility and acceptability, identify possible trends related to change among students, conduct final power calculations, and to assess the success of the study's recruitment and follow-up procedures. Phase IV (Aim 4) will test the intervention on 528 students at 12 schools (6 treatment; 6 control) using a quasi-experimental design with pretest-post-test measures at base-line and again at two month follow-up. Compared to students receiving the standard HIV prevention curriculum (control condition) at 2 months post-intervention, students participating in the Hope for the Future intervention are expected to be: (1) More confident that they can achieve their life goals; (2) Less likelihood to have experienced sexual debut; and (3) More likely to report being abstinent in the last two months. They also are expected to have: (4) greater perceived self-efficacy to abstain from sex if desired; (5) greater perceived self-efficacy to practice safer sex when sexually active; and (6) greater likelihood to report having used condoms consistently in the last two months if sexually active. If proved effective, the intervention will offer a cost-effective strategy for HIV prevention among school youth that can be rolled out-countrywide in Malawi and in the southern Africa region.

Public Health Relevance

Malawi has one of the highest HIV prevalence rates in the world, particularly among youth ages 15-23. Using a quasi-experimental design with pre and post-intervention measures, this research is designed to develop, implement and assess the effectiveness of Hope for the Future, a seven session school-based intervention specifically tailored to Malawian adolescents attending rural community secondary schools. If this innovative approach to HIV prevention for young people can be documented to be effective, it offers a cost-effective strategy for HIV prevention that can be rolled out countrywide and in the southern Africa region. ? ? ?

National Institute of Health (NIH)
Fogarty International Center (FIC)
Research Project (R01)
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Special Emphasis Panel (ZRG1-BDA-K (50))
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Liu, Xingzhu
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Kamuzu College of Nursing
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Kazembe, Abigail (2010) Question box: a tool for gathering information about HIV and AIDS. Afr J Midwifery Womens Health 4:161-165