Tag: HIV/AIDS

Title: Orphans and schooling in Africa: A longitudinal analysis

Author: David Evans and Edward Miguel

Date: 2007

Abstract: AIDS deaths could have a major impact on economic development by affecting the human capital accumulation of the next generation. We estimate the impact of parent death on primary school participation using an unusual five-year panel data set of over 20,000 Kenyan children. There is a substantial decrease in school participation following a parent death and a smaller drop before the death (presumably due to pre-death morbidity). Estimated impacts are smaller in specifications without individual fixed effects, suggesting that estimates based on cross-sectional data are biased toward zero. Effects are largest for children whose mothers died and, in a novel finding, for those with low baseline academic performance.

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Title: Malawi Orphans and Vulnerable Children Evaluation (MOVE) 

Context: Between 700,000 and 1.2 million children in Malawi have been orphaned by AIDS, and many others are vulnerable. The Funders’ Collaborative for Children (FCFC), a novel collaboration between 4 independent funding organizations, is funding an intervention that aims to establish a collaborative, replicable, and sustainable model of prevention, treatment, and care which will result in a “system of care” better able to support children and their families than the currently fragmented organization of agencies and groups.  The program is implemented in Salima District, Malawi, by Family Health International (FHI) in collaboration with XXX implementing partner organizations. Duke University and Malawi’s College of Medicine were contracted to jointly evaluate the effectiveness of the 5-year program. MOVE assesses the impact of the intervention on child outcomes in four domains: health; education; social welfare; and nutrition and livelihood. 

Study Aims: The FCFC intervention aims to improve the lives of 65 percent of vulnerable children in Salima District in terms of their education, health, livelihood, and social welfare. Researchers at Duke University and the College of Medicine will determine if the Funder’s Collaborative for Children achieved its objective.

Methods: The effectiveness of this intervention model is evaluated using qualitative and quantitative monitoring and evaluation methods. Repeated cross-sectional cluster surveys with a total of 1,260 vulnerable children and their caregivers assess district-level intervention coverage and changes in outcomes over time.  Repeat assessments with 200 of these children, half in intervention areas and half in non-intervention areas seek to attribute changes to the program.  Twice-annual surveys with implementing partners assess changes in scale and scope of service delivery.

Policy Implications:

This evaluation will determine if the FCFC intervention is effective in improving the wellbeing of orphans and other vulnerable children in Salima District, Malawi. If the evaluation demonstrates that the intervention is effective, it will help funders and national policymakers design more integrated and more effective care systems for orphans and vulnerable children.

Investigators: Karen O’Donnell (Duke University) Jan Ostermann (Duke University), Eric Umar (College of Medicine, Malawi), Kathryn Whetten (Duke University), Sara Legrand (Duke University)

Funding Source: Funders’ Collaborative for Children (Children’s Investment Fund Foundation, Comic Relief, Elton John AIDS Foundation and the Diana Princess of Wales Memorial Fund)

Contact: duke.ovcstudies@gmail.com

Study Title: Randomized Controlled Trial of Ways to Improve OVC HIV Prevention and Well-Being (Zambia CBT)

Context: With millions of youth orphaned by AIDS in sub-Saharan Africa undergoing high levels of stress-related problems—such as interpersonal and problem-solving skills deficits, unhealthy thoughts, and maladaptive behaviors—addressing trauma and stress is a pressing need. Addressing these stressors is especially important in preventing the spread of HIV by reducing stress-induced risky sexual behaviors among orphaned and vulnerable children. Other studies have shown that cognitive behavior therapy interventions, when adapted for local environments, have been effective in addressing such stress-related problems.

Study Aims: This study will focus on comparing the effectiveness of psychosocial counseling (PC) and trauma-focused cognitive behavioral therapy (TF-CBT). The study will primarily compare the effectiveness of psychosocial counseling and trauma-focused cognitive behavioral therapy in addressing the stress-related problems among orphaned and vulnerable children (OVC). In addition, the study will examine the effectiveness of these two major types of treatment in reducing sexual risk behaviors while accounting for factors that mediate and moderate HIV risk behaviors. Finally, this study will compare the cost-effectiveness of the two treatment methods.

Methods: This study, which is being conducted in Zambia, utilizes a randomized controlled trial of psychosocial counseling and trauma-focused cognitive behavioral therapy, which has been utilized in other previous and ongoing studies. The major outcomes that this study will analyze include HIV risk behaviors, emotional and behavioral health, social support, overall well-being and mental health development of OVC. Researchers will recruit adolescents aged 13-17 who report risky sexual behavior, including recent sex without a condom. Adolescent participants and their caregivers will be assessed utilizing a computerized interviewing program that will enhance privacy and honesty of responses.

Policy Implications:

  • This study will provide necessary scientific evidence on the feasibility, effectiveness, and cost effectiveness of interventions for OVC affected by HIV/AIDS.
  • Results from this study will help inform efficient program design, policy, and effectiveness of interventions for preventing HIV among OVC living in low-resource settings.

M-Principal Investigators: Laura Murray (Johns Hopkins University) and Paul Bolton (Harvard University)

Investigators: Judith Cohen (University of Pittsburg), Shannon Dorsey (University of Washington), Kathryn Whetten (Duke University),

Contact Information: duke.ovcstudies@gmail.com

 

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