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.
The proposed study represents the first evaluation of the efficacy and cost-effectiveness of an innovative and theoretically-guided intervention aimed at promoting monetary savings for secondary education, promoting microenterprise development to generate family income, and providing support programs (mentoring, workshops, and other education activities) to protect AIDS-orphaned children from future risks. Public
