The Amagugu intervention: a qualitative investigation into maternal experiences and perspectives of a maternal HIV disclosure support intervention in rural South Africa
The Amagugu intervention: a qualitative investigation into maternal experiences and perspectives of a maternal HIV disclosure support intervention in rural South Africa
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DOI：
10.1093/heapol/czx056
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发表时间：
2017-11-01
影响因子：
3.2
通讯作者：
Bland, Ruth M.
中科院分区：
文献类型：
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作者：
Mkwanazi, Ntombizodumo B.;Rochat, Tamsen J.;Bland, Ruth M.
世界卫生组织建议向 6-12 岁儿童披露父母的艾滋病毒信息。实施了孕产妇艾滋病毒披露干预措施 (Amagugu)，这是一项由非专业顾问主导、以家庭为基础的干预措施，共进行六次治疗。干预措施包括提供披露工具、为母亲提供培训和支持、为母亲和儿童举办家庭会议以及健康促进诊所访问。 Amagugu 作为一项孕产妇披露支持计划取得了成功，但人们对参与者的经历知之甚少。特意选择了来自阿马古古的艾滋病毒感染母亲（n = 20）和未感染艾滋病毒的小学学龄儿童的子样本。使用半结构化访谈和访谈指南，我们探讨了母亲在参与 Amagugu 之前对披露的看法以及参与 Amagugu 的经历。在参与者家中用 isiZulu 进行的录音采访被转录，并进行了内容分析。先前不披露的最常见原因是担心儿童了解艾滋病毒的发展能力、担心母亲及其家人受到艾滋病毒相关的耻辱以及缺乏披露的技能。干预材料、与辅导员的融洽关系以及拟议的披露程序的灵活性激励了母亲们参与。虽然对干预措施表示满意，但一些母亲仍然担心孩子对艾滋病毒的了解和保守秘密的能力。母亲们还请求支持与孩子讨论与性有关的话题。尽管以前向其他成年人透露信息的比率很高，但母亲们对向儿童透露信息的重要性知之甚少，也缺乏进行这一工作的技能。干预方法、与辅导员的融洽关系以及材料的实用性有助于克服儿童披露障碍。母亲们报告说，她们的孩子在披露信息后非常支持，并表示她们会建议其他妇女向孩子们透露信息，以获得有关艾滋病毒治疗依从性的实际支持。这一定性评估表明，有小学学龄儿童的母亲在向孩子透露信息时可能需要结构化支持，这可以通过支持性家庭咨询和用户友好的材料来实现。
The World Health Organization recommends disclosure of parental HIV to children aged 6-12 years. The maternal HIV-disclosure intervention (Amagugu), a lay counsellor-led, home-based intervention with six sessions, was implemented. The intervention included provision of disclosure tools, training and support for mothers, a family session and health promotion clinic visit for mothers and children. Amagugu demonstrated success as a maternal disclosure support programme but less is known about the experiences of participants. A sub-sample of HIV-infected mothers (n = 20) with primary school-aged HIV-uninfected children, from Amagugu, was purposely selected. Using semi-structured interviews and interview-guide, we explored maternal perceptions of disclosure prior to participation and experiences of participating in Amagugu. Audio-recorded interviews conducted in participants' homes, in isiZulu, were transcribed, and content analysis was undertaken. The most common reasons for prior non-disclosure were concerns about children's developmental capacity to understand HIV, fear of HIV-related stigma towards mothers and their families, and lack of skills to undertake disclosure. Intervention materials, rapport with counsellors, and flexibility of the proposed disclosure process motivated mothers to participate. While expressing satisfaction with the intervention, some mothers remained concerned about their children's understanding of HIV and ability to maintain confidentiality. Mothers also requested support in discussing sex-related topics with their children. Despite prior high rates of disclosure to other adults, mothers had little awareness about the importance of disclosure to children and lacked skills to undertake this. The intervention approach, rapport with counsellors, and practicality of the materials, helped overcome child disclosure barriers. Mothers reported their children as very supportive following disclosure and stated they would advise other women to disclose to children for practical support around HIV treatment adherence. This qualitative evaluation suggests that mothers with primary school-aged children may require structured support when disclosing to children, which could be achieved through supportive home-based counselling and user-friendly materials.