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

描述（由申请人提供）：认识到父母死于艾滋病对儿童的潜在严重影响，世界各地正在努力解决这些儿童的需求。这种努力必须是全面的，并包括社区的参与。此外，经常提到需要在儿童中“建立弹性”，但很少有干预工作关注这一点，而且这样的目标是否真的可以实现也是未知的。因此，拟议项目的目标是测试南非一项干预措施的有效性，该干预措施是专门为提高母亲感染艾滋病毒的幼儿的复原力而设计的。第二个目标是检查父母能够获得抗逆转录病毒（ARV）治疗对孩子的影响，这在一些资源贫乏的国家已经成为现实，但仍然是一个全球经济问题。该项目的具体目标是：(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南非幼儿的心理社会影响；(2)评估一项针对感染艾滋病毒的母亲及其子女的干预措施的有效性，以改善产妇功能，并帮助母亲提高处于3岁和6-10岁两个不同年龄和发育阶段的子女的适应能力；(3)确定影响感染艾滋病毒母亲的心理和医学因素（包括开始使用抗逆转录病毒药物），这些因素有助于改变其子女的适应功能。研究设计将是一项随机对照试验，其中440名感染艾滋病毒的母亲及其子女（按年龄组分层）将接受标准的社区服务，或者在标准服务之外，参加一个为期9个月的手册指导干预，其中包括为那些可以参加的人提供支持小组，并为那些生病的人进行家访。将在基线、第9个月和第24个月进行评价，以检验效果的可持续性。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，并确定在这方面这些工具的正常值。

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.