Promoting Resilience in Young Children of HIV-Infected Mothers in South Africa

描述(申请人提供)：认识到失去父母的艾滋病对儿童的潜在严重影响，目前正在全世界范围内努力满足这些儿童的需求。这种努力需要是全面的，并包括社区的参与。此外，经常提到有必要在儿童中“建立韧性”，但很少有干预努力有这一重点，目前尚不清楚这样的目标是否真的可以实现。因此，拟议项目的目标是测试南非干预措施的有效性，该干预措施专门旨在促进感染艾滋病毒母亲的幼儿的复原力。第二个目标是研究父母能够获得抗逆转录病毒(ARV)治疗对儿童的影响，这在一些资源匮乏的国家已经成为现实，但仍是一个全球经济问题。该项目的具体目的是：(1)通过将父母感染艾滋病毒的儿童与父母未感染艾滋病毒的儿童进行比较，描述父母感染艾滋病毒对幼儿的心理社会影响；(2)评估针对感染艾滋病毒的母亲及其子女的干预措施的有效性，以改善产妇的功能，并帮助母亲提高子女在两个不同年龄和发育阶段--3岁和6-10岁--的复原力；(3)确定影响感染艾滋病毒的母亲的心理和医学因素(包括启动抗逆转录病毒药物)，以促进其子女适应能力的变化。这项研究设计将是一项随机对照试验，440名感染艾滋病毒的母亲和她们的孩子(按年龄组分层)将接受标准的社区服务，或者，除了标准服务外，还将参加为期9个月的手动指导干预，其中包括为能够参加的人提供支持小组，以及为患病的人进行家访。将在基线、9个月和24个月进行评价，以测试效果的可持续性。与110名未感染艾滋病毒的儿童进行比较，将确定父母感染艾滋病毒对儿童的影响，并为这方面的文书确定正常值。 在接下来的几年里，数以百万计的儿童将失去他们的父母，但目前没有证据表明旨在“培养复原力”的努力可以使这些儿童受益。拟议的干预措施主要由社区志愿者提供，因此，如果被证明有效，可以在其他资源匮乏的国家复制，并可能使大量儿童受益。

DESCRIPTION (provided by applicant): Recognizing the potentially serious effects on children of losing their parents to AIDS, efforts are now being made worldwide to address the needs of these children. Such efforts need to be comprehensive and include involvement of communities. In addition, there is often mention of the need to "build resilience" in the children, but few intervention efforts have this focus, and it is unknown whether such a goal is really achievable. The goal of the proposed project, therefore, is to test the effectiveness of an intervention in South Africa that is specifically designed to promote resilience in young children of HIV-infected mothers. A second goal is to examine the effects on children of their parents being able to access antiretroviral (ARV) treatment, something that has become a reality in some resource-poor countries, but remains a global economic issue. The specific aims of the project are to: (1) Describe the psychosocial effects of parental HIV disease on young children in South Africa by comparing them to children whose parents are not HIV-infected; (2) Assess the effectiveness of an intervention for HIV-infected mothers and their children to improve maternal functioning and help mothers promote resilience in their children at two different ages and stages of development- 3 yrs, and 6-10 yrs; and (3) Identify psychological and medical factors (including initiation of ARVs) affecting HIV-infected mothers that contribute to changes in the adaptive functioning of their children. The study design will be a randomized controlled trial in which 440 HIV-infected mothers and their children (stratified by age group) will receive either standard community-based services, or, in addition to standard services, enrollment in a 9-month, manual-guided, intervention that includes support groups for those who can attend and home-visiting for those who are ill. Evaluations will be conducted at baseline, 9 and 24 months to test sustainability of effect. Comparison with 110 non-HIV-affected children will identify the effects of parental HIV disease on children and establish normal values for the instruments in this context. Millions of children will lose their parents to AIDS in the coming years, but presently there is no evidence that efforts aimed at "building resilience" can benefit these children. The proposed intervention is designed to be provided largely by community volunteers, and therefore, if proven effective, could be replicated in other resource-poor countries and potentially benefit large numbers of children.