Piloting an evidence-based intervention for HIV prevention among street youth in Eldoret, Kenya

Abstract

Objectives This study presents findings from piloting an adapted evidence-based intervention, Stepping Stones and Creating Futures, to change street-connected young people's HIV knowledge, condom-use self-efficacy, and sexual practices. Methods Eighty street-connected young people participated in a pre-and post-test mixed methods design in Eldoret, Kenya. The primary outcome of interest was HIV knowledge. Secondary outcomes included condom-use self-efficacy and sexual practices. Multiple linear regression models for change scores with adjustment for socio-demographic variables were fitted. Qualitative and quantitative findings are presented together, where integration confirms, expands on, or uncovers discordant findings. Results Participants had a significant increase in HIV knowledge from pre-to post-intervention. The median HIV knowledge score pre-intervention was 11 (IQR 8-13) and post-intervention 14 (IQR 12-16). Attendance was significantly associated with HIV knowledge change scores. Qualitatively participants reported increased HIV and condom-use knowledge and improved condom-use self-efficacy and health-seeking practices. Conclusions Our findings support the potential for further testing with a rigorous study design to investigate how best to tailor the intervention, particularly by gender, and increase the overall effectiveness of the program. Keywords HIV Á Condom use Á Evidence-based intervention Á Street youth Á Kenya Á Eldoret Á Sexual practices This article is part of the special issue ''Sexual and reproductive health of young people-Focus Africa''. The Rudolf Geigy Foundation (Basel, Switzerland) funded the open access publication of this article.

Youth engagement in HIV prevention intervention research in sub‐Saharan Africa: a scoping review

“…Following our secondary search for studies that described the interventions identified, we found 27 additional manuscripts. Thus, the total number of manuscripts reviewed was 112 [19‐130]. These manuscripts described 74 unique intervention research studies (Table 1) […”

Intersectional Stigma and Implementation of HIV Prevention and Treatment Services for Adolescents Living with and at Risk for HIV: Opportunities for Improvement in the HIV Continuum in Sub-Saharan Africa

“…This narrative draws on qualitative data collected from a study that sought to understand community perceptions of and responses to street-connected young people in Kenya that included 100 participants across 5 counties, of which 36 participants were street-connected young people aged 16 and 24 [53][54][55]. As well, this narrative draws on data and experiences from qualitative research that sought to understand street-connected children and youths' sexual and reproductive health practices [56][57][58][59], and a series of pilot studies that sought to engage street-connected young people in the HIV prevention-care continuum [60][61][62].…”

Improving livelihoods and gender equitable attitudes of street‐connected young people in Eldoret, Kenya: Results from a pilot evidence‐based intervention

“…Half (54%) of all participants reported typically sleeping in their own rented room at night, while 23% reported sleeping on the streets, in the barracks or someplace different nightly, 18% reported sleeping in a shared shelter with friends and 5% with parent(s)/guardian(s). Additional participant sociodemographics have been reported elsewhere (Embleton et al., 2020).…”

“…The Kujijenga Kimaisha programme (weeks 9–14), adapted from Creating Futures, draws on the theory and practice of sustainable livelihoods (Misselhorn et al., 2013; Misselhorn, Mushinga, Jama Shai, & Washington, 2014) sessions covered: social resources for livelihoods, saving, debt, coping with crises, basic business principles and developing an IGA (Embleton et al., 2019, 2020). Participants were encouraged to set a clear and achievable goal to work towards, such as commencing an IGA or training course.…”

“…In response, we adapted the gender transformative Stepping Stones and Creating Futures programmes (Dworkin, Treves‐Kagan, & Lippman, 2013; Gibbs et al., 2017), which address gender, livelihoods, and sexual and reproductive health, with SCY in Eldoret, Kenya, and included a microfinance component (Embleton et al., 2019). The adapted intervention was shown to significantly improve HIV knowledge and may have improved condom use knowledge and health‐seeking behaviours (Embleton, Di Ruggiero, Logie, Ayuku, & Braitstein, 2020). The present analysis seeks to explain and explore how participation in the Stepping Stones ya Mshefa na Kujijenga Kimaisha (Stepping Stones for Street Youth & Build your Life Up) programme changed SCY's gender equitable attitudes, economic resources, and livelihoods.…”