Bridges to the Future: Economic Empowerment for AIDS Orphaned Children in Uganda

通往未来的桥梁：乌干达艾滋病孤儿的经济赋权

• 批准号: 8712524
• 负责人: FRED M SSEWAMALA
• 金额: $ 60.71万
• 依托单位: COLUMBIA UNIV NEW YORK MORNINGSIDE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8712524
• 关键词: AIDS population; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adolescent; Affect; Africa South of the Sahara; Age; Attitude; Attitude to Health; Behavior; Child; Child Development; Control Groups; Cost Effectiveness Analysis; Country; Development; Economics; Education; Educational Intervention; Educational Status; Educational workshop; Family; Feeling hopeless; Future; Goals; Health; Incentives; Income; Intervention; Intervention Studies; Knowledge; Longitudinal Studies; Mental Health; Mentors; Orphan; Outcome; Participant; Patient Self-Report; Performance; Population Study; Primary Schools; Protocols documentation; Provider; Randomized; Recruitment Activity; Research; Research Personnel; Resources; Risk; Risk Behaviors; Sample Size; Sampling; Savings; School Enrollments; Schools; Seeds; Self Efficacy; Sex Behavior; Testing; Time; Uganda; base; child depression; cost effective; cost effectiveness; depressive symptoms; efficacy evaluation; empowerment; experience; improved; innovation; next generation; post intervention; programs; research study; self esteem; sexual risk taking; theories; treatment as usual; treatment effect

DESCRIPTION (provided by applicant): The proposed study evaluates the efficacy and cost-effectiveness of a family-based economic empowerment intervention for AIDS-orphaned children, called Bridges to the Future (hereafter Bridges). Bridges is guided by asset-theory and is aimed at promoting monetary savings for secondary education, promoting microenterprise development to generate family income, and providing support programs (mentoring and other education activities) to protect children from future risks. Prior research has demonstrated that an innovative economic empowerment intervention for AIDS-orphans was effective in improving short-term financial outcomes as well as academic performance and aspirations, attitudes towards sexual risk-taking, and mental health. However, studies in prior research were limited by relatively small sample sizes and assessed only short-term outcomes and attitudes towards sexual risk taking [not actual sexual behavior]. Also, prior research did not incorporate a cost-effectiveness analysis. A common challenge in intervention studies is that short-term effects may fade out over time. In addition, the relatively small sample sizes preclude an in-depth analysis of differential treatment effects by sub-group. Moreover, if economic empowerment interventions are to serve larger numbers of vulnerable children, it is essential that such programs be as cost-effective as possible. We will randomly assign 1440 AIDS-orphans (age 11 to 14 years) nested within 48 public primary schools in Rakai and Masaka Districts of southern Uganda [a region heavily affected by HIV/AIDS] to one of three study conditions: Bridges; Bridges PLUS; and a Usual care control group. Assessments will be conducted at baseline, and 12, 24, 36, and 48-months post-intervention initiation. More specifically, we will: 1) examine the direct short- and medium-term impacts of Bridges intervention on key developmental and health outcomes for AIDS-orphans, including financial/ economic stability, educational achievement, sexual risk-taking behavior, and mental health functioning, via comparing: a): A Bridges intervention condition (1:1 savings incentive match rate) to a usual care control group; b): A Bridges PLUS intervention condition (2:1 savings incentive match rate) to a usual care control group; c): A Bridges PLUS intervention condition (2:1 savings incentive match rate) to a Bridges intervention condition (1:1 savings incentive match rate); (2) evaluate the impact of the Bridges intervention on potential mechanisms of change such as self efficacy and hopelessness, educational plans and aspirations, family support, and family stability; and (3) evaluate the cost-effectiveness of alternative savings incentive match rates. The study will advance knowledge and help inform the development of the next generation of programs for AIDS-orphans in low-resource regions, including sub-Saharan Africa. In particular, the study will provide crucial evidence about the effects of economic empowerment programs on both short- and medium-term impacts and may inform decisions as to saving incentive match rates to be used in future programs.

描述（由申请人提供）：拟议的研究评估以家庭为基础的艾滋病孤儿经济赋权干预的功效和成本效益，称为通往未来的桥梁（以下简称桥梁）。桥梁项目以资产理论为指导，旨在促进中等教育的储蓄，促进微型企业的发展以创造家庭收入，并提供支持项目（指导和其他教育活动）以保护儿童免受未来风险的影响。先前的研究表明，针对艾滋病孤儿的创新经济赋权干预措施在改善短期财务结果、学业成绩和愿望、对性冒险的态度和心理健康方面是有效的。然而，先前的研究受限于相对较小的样本量，并且只评估了短期结果和对性冒险的态度[而不是实际的性行为]。此外，先前的研究没有纳入成本效益分析。干预研究的一个共同挑战是，短期效果可能随着时间的推移而消失。此外，相对较小的样本量妨碍了对亚组差异治疗效果的深入分析。此外，如果经济赋权干预措施要服务于更多的弱势儿童，就必须使这些方案尽可能具有成本效益。我们将在乌干达南部Rakai和Masaka地区（一个受艾滋病毒/艾滋病严重影响的地区）的48所公立小学中，随机分配1440名艾滋病孤儿（11至14岁）参加以下三种研究条件之一：桥梁；桥梁+;另一个是常规护理对照组。评估将在基线、干预开始后12、24、36和48个月进行。更具体地说，我们将：1)通过比较桥梁干预对艾滋病孤儿主要发展和健康结果的直接短期和中期影响，包括金融/经济稳定性、教育成就、性冒险行为和心理健康功能：a)：桥梁干预条件（1:1储蓄激励匹配率）与常规护理对照组；b)：常规护理对照组的Bridges PLUS干预条件（2:1储蓄激励匹配率）；c): Bridges PLUS干预条件（2:1储蓄激励匹配率）到Bridges干预条件（1:1储蓄激励匹配率）；(2)评估桥梁干预对自我效能感和绝望感、教育计划和愿望、家庭支持和家庭稳定等潜在变化机制的影响；(3)评估不同储蓄激励匹配率的成本效益。这项研究将促进知识的发展，并为包括撒哈拉以南非洲在内的资源匮乏地区下一代艾滋病孤儿项目的制定提供信息。特别是，该研究将为经济赋权项目对短期和中期影响的影响提供关键证据，并可能为节省激励匹配率以用于未来项目的决策提供信息。