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

描述(由申请人提供)：这项拟议的研究评估了一项以家庭为基础的经济赋权干预措施对艾滋病孤儿的有效性和成本效益，该干预措施被称为通向未来的桥梁(以下简称桥梁)。桥梁以资产理论为指导，旨在促进中学教育的金钱节约，促进微型企业发展以创造家庭收入，并提供支持计划(辅导和其他教育活动)，以保护儿童免受未来风险。先前的研究已经证明，针对艾滋病孤儿的创新经济赋权干预措施有效地改善了短期财务结果以及学习成绩和抱负、对于性冒险的态度和心理健康。然而，先前研究中的研究受到相对较小的样本量的限制，只评估了短期结果和对于性冒险的态度[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。干预研究中的一个常见挑战是，短期影响可能会随着时间的推移而逐渐消失。此外，样本量相对较小，无法按分组深入分析不同的治疗效果。此外，如果经济赋权干预措施要服务于更多的弱势儿童，这种方案必须尽可能具有成本效益。我们将随机将乌干达南部Rakai和Masaka地区(受艾滋病毒/艾滋病严重影响的地区)48所公立小学内的1440名艾滋病孤儿(年龄从11岁到14岁)随机分配到三种研究条件之一：Bridge、Bridges plus和普通护理对照组。评估将在基线以及干预开始后12、24、36和48个月进行。更具体地说，我们将：1)检查桥梁干预对艾滋病孤儿的关键发展和健康结果的直接短期和中期影响，包括经济/经济稳定、教育成就、性冒险行为和心理健康功能，通过比较：a)：A桥干预条件(1：1储蓄激励匹配率)与普通护理对照组；b)：A桥+干预条件(2：1储蓄激励匹配率)与普通护理对照组；C)：桥梁加干预条件(2：1储蓄激励匹配率)与桥梁干预条件(1：1储蓄激励匹配率)；(2)评估桥梁干预对潜在变化机制的影响，例如自我效能和绝望、教育计划和抱负、家庭支持和家庭稳定；以及(3)评估替代储蓄激励匹配率的成本效益。这项研究将增进知识，并帮助为包括撒哈拉以南非洲在内的低资源地区的艾滋病孤儿制定下一代计划提供信息。特别是，这项研究将为经济赋权计划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的决策提供参考，以便在未来的计划中使用。

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.