Accelerating progress in preventing violence against children and adolescents through multisectoral intervention packages in low- and middle-income co

在应对艾滋病的工作中，青少年是艾滋病相关死亡人数增加的唯一全球人口(联合国儿童基金会，2016)。事实上，艾滋病是非洲10-19岁青少年死亡的主要原因，在撒哈拉以南非洲的15个国家，儿童至少占人口的50%(联合国儿童基金会，2016年；人口基金，2014年)。因此，减少青少年艾滋病对于一个富有成效的劳动力市场是必要的。然而，尽管作出了国际努力，艾滋病仍然是一个重大的全球健康挑战，特别是在获得抗逆转录病毒疗法(ART)方面。在全球范围内，超过一半的符合条件的艾滋病毒阳性患者无法获得抗逆转录病毒治疗(艾滋病规划署，2016年)。非洲的治疗覆盖率估计仍然有很大的差异，从低至0%(科摩罗)到68%(卢旺达)(世卫组织，2016)。值得注意的是，国际社会正在转移对艾滋病的优先事项，因此，除一名外，14个最大的艾滋病捐赠者中的所有人在2015年都减少了资助(Kates，Wexler，&Lef，2016)。政府通过几种方式投资资金。一种机制是官方发展援助，旨在“促进发展中国家的经济发展和福利”(经合组织，2016年)。这些资金既可以通过多边组织(例如全球卫生倡议)支付，也可以通过赠款或贷款的双边方式支付(日本外务省，2011年)。GHIS指的是从政府获得资金以应对艾滋病等流行病的组织，包括全球抗击艾滋病、结核病和疟疾基金、美国总统艾滋病紧急救援计划(PEPFAR)和世界银行的多国艾滋病计划(Warren、Wyss、Shakarishvili、Atun和De Savigny，2013)。参与应对艾滋病的主要双边官方发展援助组织包括瑞典国家开发署(SIDA)、挪威国家开发署(NORAD)和美国国际开发署(USAID)。论文将解决以下问题：在撒哈拉以南非洲，哪些筹资结构最有效地促进10-19岁艾滋病毒阳性青少年的抗逆转录病毒治疗覆盖？为研究这一问题，将采取三个组成部分进行审查：1.与外国援助(即官方发展援助)相比，国内艾滋病毒筹资是否导致撒哈拉以南非洲艾滋病毒阳性青少年获得更好的治疗覆盖率？2.各国在向艾滋病毒阳性青少年提供捐助或资助时，是否继续向艾滋病毒阳性青少年提供抗逆转录病毒疗法并扩大其规模？3.腐败、民主程度、武装冲突和国家脆弱性是否缓和了援助对艾滋病毒阳性青少年提供抗逆转录病毒疗法的影响？目前正在进行一项元进程评估，以便在全球艾滋病毒应对及其潜在变化的背景下对援助执行情况进行理论分析。这个DPhil项目已经与David Humphreys教授讨论过，他同意在必要时与Lucie Cluver协商监督该项目，以获得专题支持。附加值：该项目将解决文献中的一个重大空白。这项研究首次考察了外国援助对艾滋病毒治疗覆盖率的影响，特别是对经常被忽视的青少年亚群的影响。该项目将通过对政治结构如何影响青少年健康结果的审查，为有关健康的政治经济学的新兴文献做出贡献(Ruger，2009)。值得注意的是，捐助者的资金开始趋于平缓，捐助者疲惫是方案日益严重的问题(Grépin，2012年)。该项目将提供有关援助有效性和改善卫生的最佳筹资机制的新信息。该项目以Moyo的工作为基础，通过实证(A)测试援助的长期影响，(B)分析国家筹资是否更好，以及(C)在“四匹马”的背景下检查艾滋病毒。这些调查结果将有助于非洲各国政府采取循证办法为国家艾滋病毒防治工作提供资金，并将向国际合作伙伴和捐助国通报其工作的循证政策评估。

Left behind in the AIDS response, adolescents are the only global population in which AIDS related deaths are increasing (UNICEF, 2016). In fact, AIDS is the leading cause of death among 10-19 year olds in Africa and, in 15 countries in Sub-Saharan Africa, children account for at least 50% of the population (UNICEF, 2016; UNFPA, 2014). Reducing adolescent AIDS is therefore necessary for a productive labour market. However, despite international efforts, AIDS remains a major global health challenge, notably in access to antiretroviral therapy (ART). Globally, over half of eligible HIV-positive patients lack access to ART (UNAIDS, 2016). Treatment coverage estimates for Africa remain quite varied, ranging from as low as 0% (Comoros) to 68% (Rwanda) (WHO, 2016). Remarkably, the international community is shifting priorities away from AIDS and, consequently, all but one of the 14 largest AIDS donors reduced funding in 2015 (Kates, Wexler, & Lief, 2016). Governments invest funds in several ways. One mechanism is official development assistance (ODA), which is intended to "promote the economic development and welfare of developing countries" (OECD, 2016). These funds can either be disbursed via multilateral organisations (e.g. Global Health Initiatives, GHIs) or bilaterally via grants or loans (MOFA Japan, 2011). GHIs refer to organisations receiving funds from governments to address epidemics like AIDS, including the Global Fund to Fight AIDS, Tuberculosis & Malaria, the US President's Emergency Plan for AIDS Relief (PEPFAR), and the World Bank's Multi-Country AIDS Programme (Warren, Wyss, Shakarishvili, Atun, & de Savigny, 2013). Prominent bilateral ODA organisations in the AIDS response include SIDA (Sweden), NORAD (Norway), and USAID (USA).The dissertation will address the question of: What financing structures are most effective in facilitating antiretroviral therapy coverage for HIV-positive adolescents aged 10-19 in Sub-Saharan Africa? To study this question, three components will be undertaken to examine:1. Has domestic financing for HIV led to better treatment coverage for HIV-positive adolescents inSub-Saharan Africa as compared to foreign aid (i.e. official development assistance)?2. Have countries continued provision and scale-up of ART to HIV-positive adolescents when donorfunding flat-lines?3. Do corruption, democracy levels, armed conflict and state fragility moderate the impact of aid inprovision of ART to HIV-positive adolescents? A meta-process evaluation is currently underway to theorise aid implementation in the context of the global HIV response and, subsequently, its potential variations. This DPhil project has been discussed with Professor David Humphreys, who has agreed to supervise the project in consultation, as needed, with Lucie Cluver for topical support.Added value: This project will address a significant gap in the literature. This study is the first to examine the impact of foreign aid on HIV treatment coverage, particularly on the oft-neglected adolescent subpopulation. The project will contribute to emerging literature on the political economy of health through its examination of how political structures shape adolescent health outcomes (Ruger, 2009). Notably, donor funding is beginning to flat-line and donor fatigue is an increasing problem for programmes (Grépin, 2012). The project will contribute new information on aid effectiveness and the best financing mechanisms for improving health. The project builds on Moyo's work by empirically (a) testing the long-term impacts of aid, (b) analysing whether national financing is better, and (c) examining HIV in the context of the "four horses". The findings will contribute to the initiatives of African governments toward an evidence-based approach to financing national HIV response and will inform international partners and donor-countries with an evidence-based policy evaluation of their work.