Positive Outcomes for Orphans (POFO): HIV Risk as Young Adults

艾滋病是非洲青少年死亡的主要原因，也是第二大死亡原因。 在全球青少年中，所有15-19岁的艾滋病毒新感染者中有三分之二发生在 青春期的女孩。孤儿和失散儿童成为艾滋病毒的风险特别高 被感染了。《孤儿的积极结果(POFO)：成年后感染艾滋病毒的风险》将评估各种因素 在青春期与艾滋病毒风险、艾滋病毒检测和艾滋病毒治疗参与度和留存有关 和年轻的成年人。2006-2008年，艾滋病毒/艾滋病和孤儿护理：对孤儿的积极结果 (POFO)研究采用随机抽样调查方法，招募了3057名6-12岁的家庭成员(N=1,562) 和机构护理环境(N=1,495)，代表5个文化、经济和社会领域的OSC人群 政治上截然不同的国家：埃塞俄比亚、肯尼亚、坦桑尼亚、柬埔寨和印度。经过10年的跟踪，POFO 是唯一一项对OSC进行的多国纵向研究，其研究结果直接影响了政策和 针对OSC的干预措施。所有感染艾滋病毒的青少年中有一半生活在6个国家，其中4个国家 学习。到目前为止，9%的POFO参与者(现在16-22岁)已经或被怀疑是艾滋病毒阳性，a 这一比率远远高于全国平均水平。这笔赠款的第一个目标是跟随POFO OSC队列，因为他们 过渡到青春期和青壮年，以确定与艾滋病毒风险和 相关行为。通过额外的三轮数据收集，将获得长达14年的数据 每名OSC参与者(研究完成时年龄为21-27岁)。艾滋病毒检测将在每一轮和关卡进行 将对治疗参与度和保留率的促进者进行评估。第二个目标是创造长期的- HIV相关结局的长期预测模型可以在儿童早期确定哪些OSC是 年轻人感染艾滋病毒的风险最高。所有14年的数据将用于开发模型，以支持 开发筛查工具，在生命早期识别高危OSC。为了得到允许的权重 估计代表今天的OSC，我们将比较原始的POFO样本和来自 相同区域：我们将增加一个新的250个6-16岁OSC的横断面样本(以匹配POFO I和II) 参与这项研究的四个地点(N=1,000)中的每一个都遵循最初的POFO I抽样程序。 第三个目标是确定艾滋病毒相关预防计划的地点和性别偏好。 定量调查，包括以离散选择的形式在系统变化的小插曲之间进行选择 与所有参与的OSC及其照顾者进行的实验将导致相对可接受的 在当地情况下采取不同的预防措施。这款R01具有转变范式的巨大潜力 设计和实施针对艾滋病毒风险和治疗参与的干预措施 在这一最危险的人群中。

AIDS is the leading cause of death among adolescents in Africa, and the 2nd leading cause of death among adolescents globally, with two-thirds of all new HIV infections amongst 15-19 year olds occurring in adolescent girls. Orphaned and separated children (OSC) are at especially high risk of becoming HIV infected. “Positive Outcomes for Orphans (POFO): HIV Risk as Young Adults” will evaluate factors associated with HIV risk, HIV testing, and HIV treatment engagement and retention during adolescence and young adulthood. Between 2006-8, the HIV/AIDS and Orphan Care: Positive Outcomes for Orphans (POFO) study used random sampling survey methods to enroll 3,057 OSC ages 6-12 living in families (N=1,562) and institutional care settings (N=1,495) representative of the OSC populations in 5 culturally, economically, and politically distinct countries: Ethiopia, Kenya, Tanzania, Cambodia and India. With 10 years of follow-up, POFO is the only multi-country longitudinal study of OSC and its findings have directly impacted policies and interventions for OSC. Half of all adolescents living with HIV are in 6 countries, 4 of which were included in this study. To date, 9% of POFO participants (now ages 16-22) have tested, or are suspected to be, HIV positive, a rate well above national averages. The first aim of this grant is to follow the POFO OSC cohort as they transition through adolescence and into young adulthood to identify associations with HIV risk and related behaviors. With three additional rounds of data collection, up to 14 years of data will be available for each OSC participant (ages 21-27 at study completion). HIV testing will be offered at each round and barriers and facilitators of treatment engagement and retention will be assessed. The second aim is to create long- term predictive models of HIV-relevant outcomes that identify in early childhood those OSC who are at highest risk for HIV as young adults. All 14 years of data will be used to develop models to support the development of screening tools that identify high-risk OSC early in life. In order to derive weights that allow estimates to represent today’s OSC, we will compare the original POFO sample with a new sample of OSC from the same areas: we will add a new cross-sectional sample of 250 OSC ages 6-16 (to match POFO I and II) at each of the four sites participating in this study (N=1,000) following the original POFO I sampling procedures. The third aim is to identify site- and gender-specific preferences for HIV related prevention programs. Quantitative surveys, including choices between systematically varied vignettes in the form of a discrete choice experiment conducted with all participating OSC and their caregivers, will elicit the relative acceptability of diverse prevention interventions in the local context. This R01 has significant potential to shift paradigms for the design and implementation of interventions that target the HIV risk and treatment engagement among this most at risk population.