Community interventions supporting children affected by HIV in sub-Saharan Africa: A review to derive evidence-based principles for programming¹

1. Based on a presentation given on 12 March 2008 to the US government agencies meeting on “Orphans and Vulnerable Children: Developing Research Priorities” in Rockville, MD, USA. A subset of this material has been shared in Schenk (2009) and Schenk (2008).

Abstract

Approaching 20 years after the first studies drew attention to the issues faced by children and families affected by human immunodeficiency virus (HIV), evaluation data from programs addressing their circumstances remains limited and clustered, especially when considered in relation to the magnitude of donor spending. A review of evaluation evidence was conducted to derive programming principles for interventions supporting HIV-affected children in sub-Saharan Africa, including care and support, cash transfer and HIV-prevention interventions. Methodologies of existing evaluations reflect diverse aims and research questions, and inconsistent geographical and thematic coverage. The quality of evidence was most rigorous for HIV prevention and least rigorous for care and support, and the resulting lessons learned were correspondingly variable. Evidence across the three intervention types supports several practical strategies and cross-cutting principles to guide intervention delivery, including the importance of formative research and locally tailoring interventions; community and child participation; working directly with women; multifaceted targeting strategies; actively addressing stigma; and careful oversight and monitoring of program implementation. Further efforts to build field staff capacity in monitoring and evaluation and to strengthen program management information systems are a necessary investment in building a sound evidence base to improve programs and effect tangible quality of life improvements for children and families.

Keywords:

• orphans and vulnerable children
• community intervention
• evaluation
• programming guidance
• HIV

Notes

1. Based on a presentation given on 12 March 2008 to the US government agencies meeting on “Orphans and Vulnerable Children: Developing Research Priorities” in Rockville, MD, USA. A subset of this material has been shared in Schenk (2009) and Schenk (2008).

2. See Schenk (2009) for a more detailed methodological critique of evaluation studies focused upon care and support interventions, including lessons for researchers and evaluators.

3. Websites and databases searched were: AED/SARA, AIDSPortal, Better Care Network, GH Tech, Google, Google Scholar, HIV/AIDS Impact on Education Clearinghouse, ISI Web of Knowledge, ISI Web of Science, OVCsupport.net, PubMed, Synergy Resource Centre, UNICEF Evaluation and Research database and USAID Development Experience Clearinghouse.

4. The terms “children living in HIV-affected households” and “HIV-affected children” include children whose primary caregiver(s) have died from suspected HIV-related causes, and children living in households where one or more members are HIV-positive. Both HIV-negative children and HIV-positive children are included within this category.

5. For a review of evaluation evidence in settings with concentrated or low-prevalence HIV epidemics (see Quality Assurance Project, USAID Health Care Improvement Project, & UNICEF, 2008).

6. For a more detailed review of cash transfers as a strategy for the protection and support of HIV-affected children (see Adato & Bassett, 2007).

7. For a broader review of mass-media HIV-prevention intervention evaluations in sub-Saharan Africa and beyond (see Noar, Palmgreen, Chabot, Dobransky, & Zimmerman, 2009).