HIV/AIDs and Orphan Care

据估计，全世界有1.43亿儿童失去了父母一方或双方，其中1500万儿童死于艾滋病毒/艾滋病。数百万儿童被遗弃，需要照顾。迫切需要了解个人，家庭，社区和结构性因素，影响孤儿和被遗弃儿童（OAC）的积极成果。 这项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（那加兰和海得拉巴）、肯尼亚和坦桑尼亚六个文化多样性研究地点的3,000多名随机选择的OAC现有队列。孤儿积极结局（POFO）队列中招募的儿童在基线时年龄为6-12岁;一半来自家庭环境，一半来自83个机构护理环境。儿童随访2-3年，留存率> 87%。 在2010年5月研究结束时，POFO儿童的年龄将在10-16岁之间，并正在向青春期和青年期过渡，完美地定位队列，以帮助我们了解积极结果的预测因素，如在学校的保留，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，早孕和从事性交易。该队列中的许多OAC因艾滋病毒/艾滋病而成为孤儿或被遗弃，其后果现在可能使他们面临从事使他们更有可能感染艾滋病毒和/或传播疾病的行为的风险。 我们建议对这一队列进行4年的跟踪研究，并研究个人、人际和社区层面因素对以下方面的影响：3种行为和关系结果：艾滋病毒风险行为、生殖健康和家庭形成; 3种成就结果：继续教育、创收活动（IGA）和公民参与。在拟定的研究期间，将对该队列进行14-20岁的随访。 在POFO I获得国际关注的成功基础上，该应用程序得到了杜克大学和我们合作的每个国家的组织的最高支持，并成立了一个研究咨询委员会，以帮助指导POFO I分析和POFO II设计和实施。本研究将产生至少7份同行评审的手稿、一份主要政策文件和一本书。这些文件将为决策者、方案制定者和研究人员提供咨询意见，说明在规划数百万孤儿从童年到青年的过渡时需要考虑的成长和文化特征。 公共卫生相关性：需要了解影响孤儿和被遗弃儿童（OAC）的积极成果的内在，人际和社区层面的因素，在不同的文化是紧迫的。孤儿积极成果（POFO）研究的这一竞争性继续将通过继续跟踪3,000多名OAC向青春期和青年期过渡来确定这些因素。这项研究在柬埔寨、埃塞俄比亚、印度（那加兰和海得拉巴）、肯尼亚和坦桑尼亚的六个文化多样的研究地点进行了四年。

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.