HIV infection of an adult caregiver places children at great risk for poor cognitive and psychosocial development. The increased financial insecurity, food insecurity, and emotional stress that result from caregiver HIV infection may lead to inadequate child nutrition, cognitive stimulation, and educational investment, all of which result in poor child developmental outcomes. These early disadvantages are further compounded over the life-course, leading to poverty, ill-health, and reduced social mobility in adulthood. Economic interventions, particularly those targeting poor households, may help break the link between caregiver HIV infection and poor life chances for children by bolstering child nutrition and educational investment and allowing for more effective caregiving. However, this has not been explored in the literature. My long-term career goal is to become an independent investigator with specific expertise in understanding the adult health and socioeconomic consequences of HIV-related early life-course adversity in sub-Saharan Africa. To achieve this goal, I will need additional mentorship and training in developmental psychology, qualitative methods, field experiment and household survey design, specifically as they relate to HIV-affected populations. I will draw upon this training and leverage the resources of my primary mentor David Bangsberg's extensive research infrastructure to achieve my scientific objective, which is to examine the impacts of a randomized household-level microenterprise intervention on cognitive and psychosocial development among children living in households exposed to HIV in rural Uganda and elucidate the key mechanisms behind these effects. My primary mentor's already funded longitudinal microenterprise trial provides the experimental platform for my proposed research. My central hypothesis, which follows from human capital theory, is that the microenterprise intervention will improve child cognitive and psychosocial development. I will test this hypothesis by pursuing 3 specific research aims: (1) identify key mechanisms linking household economic status and child cognitive and psychosocial development in households with HIV-infected caregivers using qualitative methods; (2) assess the impacts of the microenterprise intervention on key early childhood developmental outcomes; and (3) investigate the mechanisms underlying the developmental impacts of the intervention. I am well positioned to achieve these aims given the extensive infrastructure already in place for the parent microenterprise trial and my internationally-renowned team of mentors and advisors with expertise in HIV (Dr. Bangsberg), developmental psychology (Dr. Charles Nelson), field experiments (Dr. Bangsberg and Dr. Alexander Tsai), qualitative methods (Dr. Norma Ware), and microenterprise (Mr. Bernard Kakuhikire). The proposed research is innovative and significant: the results will provide a rich picture of how economic interventions can bolster the developmental potential of children with HIV-infected caregivers, thus informing future policy.
It is estimated that poverty places over 200 million children worldwide, many of whom reside in sub-Saharan Africa, at risk for poor cognitive and psychosocial development. Children with HIV-infected adult caregivers are at even higher risk of poor mental development than children in the general impoverished population, likely because of the increased risk of economic insecurity and psychosocial stress associated with adult caregiver HIV-infection. Consequently, focused interventions are needed to bolster the developmental potential of children with HIV-infected caregivers and, consequently, to improve their life chances. This study seeks to measure the impact of a randomized microenterprise intervention targeting households with HIV-infected adult female caregivers in rural Uganda on child cognitive and psychosocial development and to elucidate the key mechanisms underlying these effects.
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