A Systematic Review and Meta-Analysis of Interventions for Orphans and Vulnerable Children Affected by HIV/AIDS Worldwide

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.

Global, regional, and national minimum estimates of children affected by COVID-19-associated orphanhood and caregiver death, by age and family circumstance up to Oct 31, 2021: an updated modelling study

“…33 Support for such interventions by governmental, civil society, and faith sectors can divert accumulated stressors, alleviate escalating suffering, and help children to find strength, experience growth, and develop new abilities. 34,35 Two decades of coordinated HIV/AIDS programming for orphans and vulnerable children have demonstrated that investments in evidence-based programmes (eg, cash transfers, parenting support, and safe schools) promotes resilience for children, families, communities, and nations. 35 Thus, the care received after caregiver death shapes the consequences of that death.…”

“…34,35 Two decades of coordinated HIV/AIDS programming for orphans and vulnerable children have demonstrated that investments in evidence-based programmes (eg, cash transfers, parenting support, and safe schools) promotes resilience for children, families, communities, and nations. 35 Thus, the care received after caregiver death shapes the consequences of that death.…”

Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study

“… 7 Children losing primary caregivers have higher risks of experiencing mental health problems; physical, emotional, and sexual violence; and family poverty. 8 , 9 , 10 These adverse experiences raise risks of suicide, adolescent pregnancy, infectious diseases including HIV/AIDS, and chronic diseases. 11 , 12 Because of such findings, 10% of bilateral funding is invested to support orphans and vulnerable children within the multi-billion-dollar President's Emergency Plan for AIDS Relief (PEPFAR).…”

Use HIV’s lessons to help children orphaned by COVID-19

“…Globally, interventions that provide cash benefits have been shown to improve orphans' health and psychological and educational outcomes 16 . In Tanzania, for example, orphans who were randomly selected to receive cash transfers demonstrated a 22 percentage point increase in primary-school completion; the programme similarly benefited other children living in poverty 17 .…”