Publications [#221869] of Eve S. Puffer

Journal Articles

1. Matthews, E. J., Puffer, E. S., Meade, C. S., & Broverman, S. A. (2013). Implementation of a school-based HIV prevention program in rural Kenya after national dissemination. East African Medical Journal, in press.
   (last updated on 2013/12/27)

   Abstract:
   Objective: Primary School Action for Better Health (PSABH) became the national HIV prevention curriculum of Kenya in 2007. This study examined implementation of PSABH and student risk behaviors. Setting: The study was conducted in Muhuru, a rural division of Nyanza Province. Subjects: Six of nine public schools in Muhuru reported implementing PSABH. Participants were 1146 students aged 9-21 years. Measures: Anonymous surveys were administered to assess students’ exposure to PSABH program components, their sexual activity, condom use, and self-efficacy for engaging in lower risk behaviors. Results: The 6 schools with PSABH were not implementing the full program. Fifty-five percent of males and 44% of females reported a history of sexual activity. Boys who reported higher self-efficacy and learning about abstinence strategies engaged in lower risk behavior, while exposure to HIV education in assemblies and communication with relatives about HIV increased their likelihood to engage in riskier behavior. For females, condom self-efficacy was related to lower risk behavior, while HIV education during pastoral instruction was associated with higher risk. Conclusions: Previous studies in Kenya documented benefits of PSABH. However, it is unclear how effective the program is after national scale-up. In this community, PSABH was implemented at a low level, with some program components associated with higher risk behavior, calling into question how PSABH is being delivered. Implementation barriers should be examined, and studies should test strategies for ongoing support, monitoring and evaluation to increase effectiveness during program scale-up.