HIV/AIDs and Orphan Care

描述（由申请人提供）：世界范围内，估计有1.43亿儿童失去了父母中的一方或双方，仅艾滋病毒/艾滋病就有1500万儿童。还有数百万儿童被遗弃，需要照顾。了解个人、家庭、社区和影响不同文化中孤儿和被遗弃儿童（OAC）积极结果的结构性因素的需求是迫切的。这一竞争性更新申请的目标是继续跟踪柬埔寨、埃塞俄比亚、印度（那加兰邦和海德拉巴）、肯尼亚和坦桑尼亚六个文化多样性研究地点随机选择的3000多名OAC的现有队列。孤儿积极结局（POFO）队列的儿童基线年龄为6-12岁；一半来自家庭环境，一半来自83个机构护理环境。随访2 ~ 3年，留用率达87%。在2010年5月研究结束时，POFO儿童的年龄将在10-16岁之间，他们正在向青春期和青年期过渡，这一队列将完美地定位于帮助我们了解积极结果的预测因素，如在校留校、就业机会和公民参与，以及负面结果的预测因素，如高风险的性行为和吸毒行为、早孕和参与性交易。这一群体中的许多OAC是由于艾滋病毒/艾滋病而成为孤儿或被遗弃的，其后果现在可能使他们面临危险，从事使他们更有可能感染艾滋病毒和/或传播这种疾病的行为。我们建议对这一队列进行为期4年的随访，并检查个人、人际和社区层面因素对以下三个行为和关系结果的影响：艾滋病毒风险行为、生殖健康和家庭形成；以及三个成就结果：继续教育、创收活动（IGAs）和公民参与。在拟议的研究期间，该队列将被跟踪到14-20岁。该应用程序在获得国际关注的POFO I的成功基础上，得到了杜克大学和与我们合作的每个国家的组织的最高水平的支持，并成立了一个专门研究的咨询委员会，以帮助指导POFO I的分析和POFO II的设计和实施。这项研究将产生至少7篇同行评审的手稿，一份主要的政策文件和一本书。这些文件将为政策制定者、规划人员和研究人员提供建议，说明在为数百万孤儿从童年过渡到青年成年进行规划时需要考虑的照料和文化特征。

DESCRIPTION (provided by applicant): Worldwide, 143 million children are estimated to have lost one or both parents, 15 million to HIV/AIDS alone. Millions more children have been abandoned and are in need of care. The need to understand individual, family, community, and structural factors influencing positive outcomes for orphaned and abandoned children (OAC) across and within different cultures is pressing. The goal of this competing renewal application is to continue to follow an existing cohort of more than 3,000 randomly selected OAC in six culturally diverse study sites in Cambodia, Ethiopia, India (Nagaland and Hyderabad), Kenya, and Tanzania. Children enrolled in the Positive Outcomes for Orphans (POFO) cohort were aged 6-12 at baseline; half were enrolled from family settings, half from 83 institutional care settings. Children were followed for 2-3 years with a retention rate of >87%. POFO children will be aged 10-16 at the close of the study in May 2010 and are transitioning to adolescence and young adulthood, perfectly positioning the cohort to help us understand predictors of positive outcomes such as retention in school, employment opportunities, and civic engagement, and predictors of negative outcomes such as high risk sexual and drug use behaviors, early pregnancy, and engagement in sex trade. Many of the OAC in this cohort were orphaned or abandoned due to HIV/AIDS, the consequences of which may now place them at risk for engaging in behaviors that make them more likely to become HIV infected and/or spread the disease. We propose to follow this cohort for 4 years and examine the influence of intrapersonal, interpersonal, and community level factors on: 3 behavioral and relationship outcomes: HIV risk behaviors, reproductive health, and family formation, and 3 achievement outcomes: continued education, income generating activities (IGAs) and civic engagement. The cohort will be followed through ages 14-20 during the proposed study period. Building on the success of POFO I, which has received international attention, this application has the highest level of support from Duke University and organizations in each of the countries with which we have been working, and a study-specific Advisory Board has been formed to help guide POFO I analyses and POFO II design and implementation. A minimum of 7 peer-reviewed manuscripts, a major policy document, and a book will result from this study. These documents will advise policymakers, programmers, and researchers on the caregiving and cultural characteristics that need consideration when planning for the transition of millions of orphaned children from childhood into young adulthood. PUBLIC HEALTH RELEVANCE: The need to understand intrapersonal, interpersonal, and community level factors influencing positive outcomes for orphaned and abandoned children (OAC) across and within different cultures is pressing. This competing continuation for the Positive Outcomes for Orphans (POFO) study will identify such factors by continuing to follow more than 3,000 OAC as they transition to adolescence and young adulthood. The study is conducted over four years in six culturally diverse study sites in Cambodia, Ethiopia, India (Nagaland and Hyderabad), Kenya, and Tanzania.