IMPLEMENTATION OF A SCHOOL-BASED HIV PREVENTION CURRICULUM FOLLOWING NATIONAL DISSEMINATION IN NYANZA PROVINCE, KENYA.

BACKGROUND: Primary School Action for Better Health (PSABH) became the national HIV prevention curriculum of Kenya in 2005. OBJECTIVE: To examined implementation of PSABH and student risk behaviour s. SETTING: Muhuru, a rural division of Nyanza Province. SUBJECTS: One thousand one hundred and forty six students aged 9-21 years from six primary schools in Muhuru. OUTCOME MEASURES: Anonymous surveys were administered to assess students'exposure to PSABH curriculum components, sexual activity, condom use, and self-efficacy related to engaging in lower risk behaviours. RESULTS: The six schools implementing PSABH were not implementing the full curriculum. Fifty-five percent of males and 44% of females reported a history of sexual activity. For females, condom self-efficacy was related to lower risk behaviour, while HIV education during pastoral instruction was associated with higher risk. Boys who reported higher self-efficacy and learning about abstinence strategies engaged in lower risk behaviour , while exposure to HIV education in assemblies and communication with relatives about HIV was associated with higher risk. CONCLUSION: Previous studies documented benefits of PSABH. However, it is unclear how effective the curriculum is after national scale-up. In this community, PSABH was implemented at a low level, with some curriculum components associated with higher risk behaviour, calling into question how PSABH is being delivered. Future studies should examine effective strategies for ongoing support, monitoring, and evaluation. Successfully disseminating evidence-based prevention strategies could reduce HIV incidence and the burden on healthcare providers struggling to care for people living with HIV/AIDS.

Adherence to HAART among patients with HIV: breakthroughs and barriers.

Highly active antiretroviral therapy (HAART) has been a major breakthrough for the treatment of patients with HIV; however, adherence to treatment remains a formidable barrier. This paper evaluates the current state-of-the-science in adherence to HAART. Barriers to treatment success, determinants of adherence and interventions to improve adherence are reviewed. Overall, multifaceted interventions appear most promising. We conclude with recommendations to enhance clinical practice and improve treatment outcomes for patients with HIV. Despite substantial attention to adherence in recent years, much more remains to be done to understand and promote adherence to HAART.