Abstract

Background

Worldwide, there are more than 13.3 million orphans and vulnerable children affected by Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) (HIV OVC), defined as individuals below the age of 18 who have lost one or both parents to HIV/AIDS or have been made vulnerable by HIV/AIDS; they are at risk for negative psychosocial and cognitive outcomes.

Purpose

This meta-analysis aimed to examine the scientific literature on available interventions for HIV OVC, with a focus on community-based interventions (CBI).

Methods

Systematic electronic searches were conducted from four databases between October 2016 and April 2017 to identify articles investigating the effectiveness of interventions for HIV OVC. Effect sizes were calculated for each article which provided enough information and data points for analyses.

Results

Seventy-four articles were reviewed, including psychosocial interventions (d = 0.30), cognitive interventions (d = 0.14), social protection interventions (d = 0.36), and community-based interventions (CBI; d = 0.36). Study-specific effect sizes varied widely, ranging from −1.09 to 2.26, that is, from a negative effect to an impressively large positive one, but the majority of studies registered small to medium effects (the overall effect size for all studies was 0.32, SE = 0.03, 95% CI: 0.26–0.37). Social protection interventions had the highest positive outcomes whereas CBI tended to have the fewest significant positive outcomes, with some outcomes worsening instead of improving.

Conclusions

Overall, interventions provided to OVC have potential for improving cognitive, psychosocial, and risk-behavior outcomes. Social protection interventions and CBI had the highest effect sizes, but CBI had positive effects on fewer outcomes and demonstrated some negative effects. CBI warrant scrutiny for improvement, as they represent an important form of culturally embedded services with potentially long-term benefits to OVC, yet appear to be differentially effective. Successful components of other types of intervention were identified, including cash grants, mentorship, and family therapy. In addition, more research is needed that attends to which interventions may be more effective for specific populations, or that studies cost-effectiveness.

中文翻译：

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对全球受艾滋病毒/艾滋病影响的孤儿和弱势儿童干预措施的系统回顾和元分析。

摘要

背景

在全球范围内，有超过 1330 万孤儿和弱势儿童受到人类免疫缺陷病毒感染和获得性免疫缺陷综合征 (HIV/AIDS) (HIV OVC) 的影响，这些儿童被定义为 18 岁以下失去父母一方或双方感染 HIV 的个体/AIDS 或因 HIV/AIDS 而变得脆弱；他们面临负面心理社会和认知结果的风险。

目的

这项荟萃分析旨在检查有关 HIV OVC 可用干预措施的科学文献，重点是基于社区的干预措施 (CBI)。

方法

2016 年 10 月至 2017 年 4 月期间，从四个数据库中进行了系统的电子搜索，以确定调查 HIV OVC 干预措施有效性的文章。每篇文章都计算了效果大小，这为分析提供了足够的信息和数据点。

结果

回顾了 74 篇文章，包括社会心理干预 ( d = 0.30)、认知干预 ( d = 0.14)、社会保护干预 ( d = 0.36) 和基于社区的干预 (CBI；d = 0.36)。研究特定的效应大小差异很大，从 -1.09 到 2.26，即从负面影响到令人印象深刻的巨大正面影响，但大多数研究记录了小到中等效应（所有研究的总体效应大小为 0.32，SE = 0.03, 95% CI: 0.26–0.37)。社会保护干预的积极成果最高，而 CBI 的显着积极成果往往最少，一些成果不是改善而是恶化。

结论

总体而言，向 OVC 提供的干预措施具有改善认知、社会心理和风险行为结果的潜力。社会保护干预和 CBI 的效应量最大，但 CBI 对较少的结果产生积极影响，并表现出一些负面影响。CBI 值得对改进进行审查，因为它们代表了一种重要的文化嵌入服务形式，对 OVC 具有潜在的长期利益，但似乎效果不同。确定了其他类型干预的成功组成部分，包括现金补助、指导和家庭治疗。此外，还需要更多的研究来关注哪些干预措施可能对特定人群更有效，或者研究成本效益。