• 18 Month Evaluation of the Basic Model in Nyanza Province
• 30 Month Evaluation of the Basic Model in Nyanza Province
• 10 Month Evaluation of the modified model delivered in Nairobi, Urban Coast, Mount Kenya and Western Kenya.

The Basic Model of PSABH trained the head teacher (or deputy head), 1 resource or senior teacher, and 1 community representative in a series of two, week-long training sessions. The trained teachers then trained their colleagues and provided HIV/AIDS education in the classrooms and co-curricular activities in their schools. One to two terms after teachers were trained, 4 peer supporters and one additional teacher-supervisor were trained in a similar one-week training course.

The Modified Model of PSABH that is being delivered across Kenya trains the head teacher (or deputy head), 1 resource or senior teacher, and 1 community representative in a week-long training session. One term later, 2 additional teachers are trained in a week-long session. This provides each school with 4 trained teachers and a trained community representative. As in the Basic Model, the trained teachers are expected to train their colleagues and to provide HIV/AIDS education in the classrooms and co-curricular activities in their schools. In addition, a term after the final teacher training, primary schools in communities that also have a secondary schools send 4 peer supporters and a teacher-supervisor for a similar one-week training session.

PSABH trains teachers to deliver HIV/AIDS education with a particular focus on prevention of spread and care for those infected by infusing and integrating lessons across the entire school curriculum and through special activities incorporated into school clubs and school-wide activities. There is no fixed time-frame for the programme, instead the teaching, learning and activities occur on an on-going basis throughout the school year.

The 18 Month Evaluation Summary compares pre-programme and 18 month post-programme-initiation responses to self-completion surveys (pupils and teachers), focus group discussions with pupils and semi-structured interviews with teachers. 160 schools in Nyanza Province were selected as intervention and control sites using cluster randomized sample selection. Surveys were completed by over 10,000 standard 6 and 7 pupils and 500 teachers in November 2001 and October 2003, and focus groups and interviews were conducted with smaller subsamples during the same time periods.

Key questions addressed in this portion of the evaluation included:

• How successful has PSABH been in getting schools to take up various components of teaching about HIV and AIDS?
• What is the effect of PSABH on the AIDS-related knowledge, attitudes and behaviours of standard 6 and 7 pupils?

This summary also provides comments on results obtained from testing 5 variations of the Basic Model. These included:

• training 2 additional teachers
• training health workers to visit schools to support teachers and address condom use as a harm reduction strategy
• training church leaders together with teachers to increase the consistency of the messages in the communities
• comparing schools with to those without trained peer supporters
• a cost-share model where schools covered a portion of the training costs.

The latter two variations were tested using 60 schools in Rift Valley province.

Research Design: 30 Month Evaluation of Basic Model

The 30 Month Evaluation Summary uses 20 of the sampled intervention sites in Nyanza Province to compare pupil and teacher survey, focus group and interview responses 30 months post-programme initiation, to those obtained at 18-months and prior to training. Over 3000 pupils and 130 teachers completed surveys. The 30 month data were collected in October 2004. The key question addressed in this portion of the evaluation was:

• Have the gains observed by 18 months post-programme initiation in implementation, knowledge, attitudes and practices been maintained at wave 4¹?

Research Design: 10 Month Evaluation in Five New Sites

The 10 Month Evaluation Summary uses 16-25 schools from each of 5 new regions participating in the roll-out of the Modified Model of PSABH to all primary schools in Kenya. These regions included; Nairobi schools drawing pupils from families with formal incomes, Nairobi schools drawing pupils from informal settlements, Urban Coast schools, schools in Mount Kenya and in Western Kenya. A random sample of schools from each of these regions was selected from among those that sent a full complement of teachers to the first training session. Pre-programme data were collected in December 2004-January 2005 and 10 month post-programme initiation in October 2005. Repeated cross-sectional samples involved over 10,000 standard 6 and 7 pupils and 200 teachers in survey completion with a subset also participating in focus groups or semi-structured interviews.

The central question of this phase of research was:

• Can PSABH be delivered and have an impact similar to that observed in Nyanza in different regions that serve pupils from different ethnic groups?

Primary School Action for Better Health - an HIV/AIDS behaviour change intervention that has proved effective in 2,000 Kenyan primary schools (pupils aged 11 - 17 yrs). Based on evaluation of 160 schools in Nyanza province randomly assigned to intervention and control conditions. Repeated cross-sectional samples of youth (>10,000), and teachers (>2000). Baseline data collection Nov 2001-Feb. 2002; 18 month post data collection Oct. 2003.

Focus group discussions with pupils in target schools conducted post-programme indicated a dramatic shift in pupils` ability to describe concrete methods they now used to avoid or refuse sex. The language they used confirmed that they ‘owned’ these new behaviour patterns. This supported the observed statistically significant changes

Qualitative Contradiction

Contrary to quantitative findings for knowledge, focus group discussions with pupils in target schools revealed considerable accuracy and breadth of knowledge about HIV/AIDS post-programme. This is compared to pre-programme qualitative findings, which suggested inaccurate knowledge founded upon numerous myths and misinformation. Post-programme pupils in target schools were also able to dispel such myths and misinformation by using reasoning and critical thinking skills. There was ample evidence that pupils in target schools understood how best to stay safe from HIV.

At all waves of data collection teachers and community leaders presented abstinence as the only truly effective method of preventing transmission and acquisition of HIV. Over time teachers gradually incorporated specific teaching strategies to help pupils remain abstinent as well as increase their sense of personal control and efficacy when it came to sexual decision-making. By the final evaluation pupils and teachers alike were listing positive reasons for abstaining compared to baseline and the intermediate data collection exercise when the main reason for abstinence was to avoid AIDS and death.

Baseline and intermediate analyses suggested discouraging news about condoms as the content of messages delivered to youth was largely negative and at times inaccurate. Teachers struggled with the issue of condoms, not knowing how or if they should talk about them to pupils. Pupils recognized such discomfort on the part of adults but still looked to them for the truth about condoms. By the final evaluation, although teachers still did not publicly support teaching pupils about condoms, there appeared to be more open talk of condoms with youth. While discussions tended to focus on persuading youth against condom use there were more indications of attempts by teachers to acknowledge the preventive nature of condoms. Post-programme, pupils who were sexually experienced had more accurate knowledge about condoms and held more accepting attitudes about condoms than those who had never engaged in sexually activity. The difference was stronger in target than control schools.

Success Indicators of Basic Model

• Target schools have statistically significant higher levels of a comprehensive, sustainable HIV/AIDS programme integrated throughout school activities.


• Success of programme at large scale (2,000 schools) and resilience in context of teacher strike and introduction of FPE proves robustness of approach suitable for national dissemination.


• High rate of adoption of training in non-target schools by Ministry training teams indicates broad acceptance and self-perpetuating nature of the programme.


• Pupil responses confirm direct relationship between training of teachers and messages delivered and capacity of programme to adjust in response to pupil needs and teachers` concerns.

Considerations Based on Variations Tested

• High rate of teacher movement (22% schools lost trained teachers to transfer or death over 18 months)


• Additional teachers improves programme implementation levels.


• School visits by trained health workers assists with sensitive topics such as prevention of infection.


• Church leaders are important influences on teachers and pupils.


• Peer Supporters improve the nature and level of communication on HIV risk reduction.

Primary School Action for Better Health - an HIV & AIDS behaviour change intervention that has proven effective in 2,000 Kenyan primary schools (pupils aged 11 - 17 yrs).

Data collection: baseline (wave 1): Nov 2001-Feb 2002; 18 mos (wave 3): Oct . 2003; 30 mos (wave 4): Oct. 2004.

The summary below is based on 20 target schools in Nyanza Province that have continued to be followed beyond the 18 month evaluation period. Results here compare the pre-programme to 30 month post programme results only for these schools; there is no comparison with control sites. Because of the absence of control sites, these results must be considered as only supplementary to those reported at 18 months, which included control sites in the analysis.

Pupil Behaviour and Attitudes

The stabilizing effect of PSABH on the sexual activity of boys in target schools compared to their activities in control schools was only evident when control schools were part of the analysis. Without control schools there appears to be no change in much of boys` sexual behaviours. This should be considered in light of the increases in the sexual activity of boys in control schools evidenced at wave 3.

Qualitative Confirmation

In focus group discussions pupils demonstrated a continued shift in pupils’ ability to describe concrete methods they now used to avoid or refuse sex. The language they used confirmed that they `owned` these new behaviour patterns. This supported the observed statistically significant changes.

Pupil Knowledge

Qualitative Confirmation

Focus group discussions with pupils in target schools revealed considerable accuracy and breadth of knowledge about HIV/AIDS post-programme. This is compared to pre-programme qualitative findings, which suggested inaccurate knowledge founded upon numerous myths and misinformation. Post-programme pupils in target schools were also able to dispel myths and misinformation by using reasoning and critical thinking skills. There was ample evidence that pupils in target schools understood how best to stay safe from HIV.

Teachers` Abilities

At all waves of data collection teachers and community leaders presented abstinence as the only truly effective method of preventing transmission and acquisition of HIV. Over time teachers gradually incorporated specific teaching strategies to help pupils remain abstinent as well as increase their sense of personal control and efficacy when it came to sexual decision-making. Schools were also inviting outsiders, such as health workers, into the school to address the issue of condoms for prevention of HIV transmission. By 30 months after training,: (1) pupils and teachers were listing positive reasons for abstaining compared to baseline and the intermediate data collection exercise when the main reason for abstinence was to avoid AIDS and death, (2) pupils were discussing how condoms could prevent HIV transmission, and (3) although teachers still did not publicly support teaching pupils about condoms, there appeared to be more open talk of condoms with youth. While discussions tended to focus on persuading youth against condom use in favour of abstinence, there were more indications of attempts by teachers to acknowledge the preventive nature of condoms.

Qualitative Explanation

In focus groups with pupils and interviews with teachers, the fall-off in the question box was attributed to the loss of trained teachers and peer supporters in some schools. The fall-off in the school health club was attributed to activities being taken-up in other school clubs. Both of these accounted for the slight drop in the pupil participation scores.

Primary School Action for Better Health (PSABH), is an HIV/AIDS behaviour change intervention developed by CfBT, Kenya and funded by DFID that demonstrated its effectiveness in primary schools in Nyanza and Rift Valley Provinces over a 30 month evaluation period from Oct. 2001 to Oct. 2004. PSABH began expanding to primary schools across Kenya in 2005. To evaluate this expansion, pre- (Dec. 2004-Jan. 2005) and post-programme (Oct. 2005) data were collected using pupil and teacher surveys, focus group discussions and interviews in 16-25 schools in each of five regions of Kenya where PSABH was delivered. These included Nairobi schools drawing students from families with fixed incomes (NFI), Nairobi schools serving informal settlements (NIS), schools in the urban regions of Mombasa and Malindi in Coast Province (UC), and schools in the Mount Kenya (MK) and Western Kenya (WK) regions. In each region, between 1660-1920 standard 6 and 7 pupils and 36-48 teachers were surveyed and 40 pupils and 8 teachers participated in focus groups or in-depth interviews in December 2004-January 2005 and October 2005.

Pupil Attitudes and Behaviours

Statistically Significant Changes:

From pre- to post-programme, with respect to the sexual behaviour of pupils, schools evidenced significantly:

1. More boys and girls reporting they `can say no to sex` and that `a girl means no when she says no`
2. More boys and girls reporting they avoided places in order to avoid engaging in sex - with the exception of NFI, where fewer boys reported avoidance.
3. More boys and girls refusing to engage in sex in MK and WK; and more girls in NIS and UC - there were fewer boys reporting refusal in NFI.
4. More girls reporting sexual activity in NFI, NIS and WK and more boys in NFI, UC and MK. This was due primarily to more reporting sexual activity before PSABH began as evidenced in results for `debut pre-programme,` and not to more youth initiating sexual activity during the programme.

From pre- to post-programme, with respect to condom use by pupils, schools evidenced significantly:

1. Fewer boys saying they can make sure a condom is used in NIF, NIS, and WK, fewer girls in NFI and MK; more boys saying they can make sure a condom is used in MK and more girls in WK
2. Consistent with feelings about making sure a condom is used, more boys reporting condom use in MK and fewer boys in NIS. Results are inconsistent for girls in WK with fewer reporting condom use.

Qualitative and Quantitative Insights

Focus group discussions confirmed pupils' sense of confidence that they could avoid or resist engaging in sexual activity. The seemingly poor results for engaging in sex was the result, in most districts, of events that occurred before the PSABH programme. In all regions, pupils in focus group discussions reported bodily urges and peer pressures as the factors that most often made abstinence difficult. Focus group discussions related to confidence and use of condoms produced mixed results with some pupils expressing confidence in their ability to use condoms while others were uncertain about the wisdom of condom use or their ability to use them.

Pupil and Teacher Knowledge

Statistically Significant Changes:

From pre- to post-programme, schools evidenced significantly:

1. Higher mean knowledge scores for teachers in NFI, NIS, and WK, but lower scores in MK
2. Higher mean knowledge scores for pupils in NFI, UC and MK.

There were also large and significant gains in the percentage of pupils pursuing information about HIV and AIDS on their own and communicating with teachers and parents about the subject.

Qualitative and Quantitative Insights

While mean knowledge scores of pupils and teachers increased in several regions, the gains were uneven across different areas of knowledge. For example, while pupil knowledge that abstaining from sex offered protection from HIV remained high, fewer pupils responded correctly to questions about the ability of condoms or reduction in number of partners to reduce the risk of infection. In several regions, the percentage of pupils who responded correctly to questions about condoms decreased over the course of the programme. The gaps in knowledge about condoms were confirmed in focus groups where pupils demonstrated a mixture of correct and incorrect information. While most teachers responded correctly to questions about condoms on the survey, in interviews, as well as on surveys, they expressed reluctance to teach that condoms could reduce the risk of HIV transmission.

Teachers` Abilities

Both pre- and post-training, teachers and community leaders presented abstinence as the only truly effective method of preventing transmission and acquisition of HIV. They encouraged pupils to avoid behaviours, peers and situations that could lead to sexual activity and to find ways to control their bodily urges. The content of messages delivered to youth about condoms was largely negative and at times inaccurate. Teachers struggled with the issue of condoms, not knowing how or if they should talk about them to pupils.

School Response

Schools in all regions demonstrated increases in teaching about HIV and AIDS as part of classroom subjects, in the presence of question boxes and clubs that addressed HIV and AIDS, and in the HIV/AIDS content of other co-curricular activities. In addition, there were significant decreases in the number of barriers to teaching about HIV and AIDS reported by teachers in most regions. Structural barriers (e.g., insufficient time and shortage of resources) rather than personal, pupil or community barriers were the most commonly mentioned post-programme.

Of note is that almost all schools reported a large number of trained peer supporters in their pupil population. This is well beyond the training provided by PSABH and suggests that other organizations are training peer supporters in primary schools.

Comparison to Nyanza and Rift Valley Results

These results are consistent with results for Nyanza and Rift Valley Provinces at comparable time periods post-programme.