HIV/AIDs and Orphan Care

描述(申请人提供)：据估计，全世界有1.43亿儿童失去了单亲或双亲，仅艾滋病毒/艾滋病就有1500万。数以百万计的儿童被遗弃，需要照顾。迫切需要了解影响孤儿和被遗弃儿童(OAC)积极结果的个人、家庭、社区和结构性因素，无论是在不同的文化中还是在不同的文化中。这一竞争性续签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不同文化背景的研究地点的3000多个随机选择的现有OAC队列。在孤儿积极结果(POFO)队列中登记的儿童基线年龄为6-12岁；一半来自家庭环境，一半来自83个机构护理环境。对儿童进行了2-3年的随访，保留率为87%。POFO儿童将在2010年5月研究结束时年龄在10-16岁之间，并正在过渡到青春期和青春期，这一群体的完美定位有助于我们了解积极结果的预测因素，如留校、就业机会和公民参与，以及消极结果的预测因素，如高风险性行为和吸毒行为、早孕和从事性交易。这一队列中的许多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为期4年的跟踪调查，考察个人、人际和社区层面的因素对以下3种行为和关系结果的影响：HIV危险行为、生殖健康和家庭形成，以及3种成就结果：继续教育、创收活动(IGAs)和公民参与。在拟议的研究期间，该队列将一直跟踪到14-20岁。在受到国际关注的POFO I成功的基础上，这项申请得到了杜克大学和我们一直在与之合作的每个国家的组织的最高级别的支持，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篇同行评议的手稿、一份重要的政策文件和一本书。这些文件将就照顾和文化特征向政策制定者、程序员和研究人员提供建议，这些特征在规划数百万孤儿从童年过渡到年轻成人时需要考虑。 公共卫生相关性：迫切需要了解影响孤儿和被遗弃儿童(OAC)积极结果的个人、人际和社区层面的因素，无论是在不同的文化中还是在不同的文化中。这项针对孤儿积极结果(POFO)的竞争性延续研究将通过继续跟踪3000多名OAC在他们过渡到青春期和成年期时确定这些因素。这项研究在柬埔寨、埃塞俄比亚、印度(那加兰和海德拉巴)、肯尼亚和坦桑尼亚的六个不同文化背景的研究地点进行了四年多的时间。

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.