An A-Z of research disasters Lucie Cluver Puff adders, taxi lords and budgets from hell.

Collaborative OVCY research Universities: Oxford, UCT, Wits, Curtin, UKZN Collaborative research: science to assist policy

Longitudinal panel survey of AIDS-orphanhood: 1025 children, year longitudinal survey 2005: N=1021 (aged 10-18) 2009: 71.5% follow-up 3 provinces South Africa Comparing AIDS-orphaned/other- orphaned/non-orphaned children Measures and analysis: Standardised scales, national surveys (census, DHS etc.) Verbal autopsy method (sensitivity 83%, specificity 75%) multivariate logistic, log-linear and mediation modelling All controlling for socio-demographics Qualitative link studies Pilot and follow-up: n=290 children

National longitudinal study: 6850 children, 2500 adult caregivers, Longitudinal national survey Main study: N=6000 (age: 10-18) 3 provinces South Africa; 6 sites >30% prevalence Stratified random sampling of census EAs Every household with a child aged Urban/rural, 1 year follow-up in 2 provinces (n=3401, 97% follow-up) Measures Standardised scales, national surveys Transactional sex, age-disparate sex, sex using substances, unprotected sex, multiple partners Ethics Approved by University of Cape Town, Oxford, KwaZulu-Natal, Province Health & Education Depts Social & health service referrals Controlling for prior HIV risk

Adapt the best evidence-based programs for child abuse prevention to sub-Saharan Africa Work collaboratively with government, UNICEF, WHO, NGOs and communities To pre-test, improve, pre-test, improve and test in RCTs If they work, to provide freely within the developing world Sinovuyo Teen – Parenting for Lifelong Health Recruitment Baseline data collection Control wait-listIntervention group Treatment as usual 1-year follow-up data collection Immediate post-test data collection Random allocation Group intervention, ongoing peer support Control group: group intervention, ongoing peer support

Can be almost any cause: Riots, strikes, floods Under-estimating how long things take Staff crises/exhaustion Contracts/funding/running out of cash Some helpful responses: Accept that it will never be perfect Always make Plan B (and have a secret Plan C) Try to have some back-up cash (I need to follow own advice here) Encourage/force team to tell you as soon as things start going wrong Don’t blame them – problem-solve together Apologise to them if you messed up.

Common causes: Urban: political violence, violent crime Rural: snakes, escaped animals All: road accidents Things that might help: Safety protocols: plan with team Community and community leader liaison Community crime leader liaison Travelling in pairs Staff safety has to be the priority in all decisions Insurance and car licenses. Training for all drivers. This is a complete nightmare and never gets better.

Common causes: Over-exposure to child abuse Working too hard – exhaustion Child disclosure of really horrific abuse Inability to help sufficiently Often leads to staff arguments and tension Some ways of approaching this Regular supervision Treats, Enforced holidays Staff need to know you’ve got their back Action – referrals and helping kids (also part of ethics)

Common causes Political interference Local gatekeepers Riots/floods/fires/war etc. Some things that help Make staff safety the priority, Be realistic. Not everything has to go into the publication… Do the best you can in each circumstance Call/write and ask for advice Tell your funders (if there’s a good reason)

Some key issues Kids completely uninterested in detailed IRB consent forms, verbal description crucial Field staff – perverse incentives against informed consent No guardian/abusive guardian When you have to break confidentiality Some responses: Engage with ethics committees Have a social worker/psychologist to supervise field staff Don’t make payment/success dependent just on recruitment numbers Can get alternative consent Be strong for your team.

Common causes Overburdened health/social services Staff burnout Remote, rural areas far from services Some things that help Mapping services before you start Find good professionals Have a social worker to supervise staff Emergency protocols i.e. rape cases Just do stuff if it’s needed – sort out the details later Providing disclosure-handling skills to field staff

Can be really tricky Children move homes Areas get destroyed Cellphones die No administrative data Some things that help Get three names addresses and cell numbers of people who would be able to find them Send back the same interviewers Certificates help people remember and find kids again This is like detective work – set money aside, and be tenacious!

Nobody will know your findings if: You don’t actively disseminate You don’t market findings at the right level People/organisations feel they are being attacked Some helpful ideas: Make a list of ‘who needs to know this’ at community, provincial, national, international level Engage with them early, ideally in planning stages of the research – make them involved and make your research more useful Ask how they would like results: presentations/policy briefs/video Use the media: local radio, newspapers, your org’s press office

Get your research out there: Have a very simple, clear message (in 1 sentence!) Simplify results, don’t try to look clever Use graphs/pictures not words Publishing in peer- reviewed journals can really help. Worth the hassle (eventually). Give credit to the NGOs/governments involved.

Cluver, L (2011). Nature, Parental AIDS predicts child abuse ( OR1.8 CI )

Compound effects of abuse & parental AIDS on child risk of transactional sexual exploitation Cluver, L, Orkin, M, Boyes et al, (2011). JAIDS

Moderated mediation model 59: (Hayes 2012), controlling for age, baseline HIV risk behavior p<.001 B-.82 Severe poverty Physical/e motional abuse HIV-risk behavior incidence Care & support Economic support p<.047 B.151 p<.001 B.15 p<.001 B-.11 Mechanism 4: Care and support reduces HIV-risk behavior through abuse

The Nuffield Foundation Funders: thank you. National Department of Social Development The National Research Foundation HEARD, University of KwaZulu-Natal The John Fell Fund The Claude Leon Foundation The Economic & Social Research Council Regional Interagency Task Team for Children Affected by AIDS – Eastern & Southern Africa

I’m not the only one going through this. There are many other kids in the same situation. I would like to say to them that they mustn’t give up. They must just accept it and at the end of the day believe that they will succeed at something. They mustn’t give up. TAG team member, 14 yrs.