Enhancing Ugandan HIV-Affected Child Development with Caregiver Training

通过护理人员培训促进乌干达受艾滋病毒影响的儿童发展

• 批准号: 8208859
• 负责人: Judith Karen Bass
• 金额: $ 48.82万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8208859
• 关键词: 5 year old; Address; Affect; Age; Area; Attention; Behavior; Behavioral; Caregivers; Caring; Child; Child Development; Child Mortality; Cognitive; Color; Computers; Control Groups; Depressed mood; Development; Disadvantaged; Disease; Economics; Education; Educational Intervention; Effectiveness; Emotional; Equipment and supply inventories; Family; Goals; Growth; HIV; HIV Seropositivity; Health; Health education; Home environment; Intelligence; Intervention; Lead; Learning; Liquid substance; Measures; Mediating; Medical; Memory; Mental Health; Methods; Mothers; National Institute of Mental Health; Nature; Nursery Schools; Nutritional; Orphan; Outcome; Personal Satisfaction; Phase; Population; Preschool Child; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Research; Resources; Role; Rural; Social Development; Social support; Stress; Structure; Subgroup; Testing; Therapeutic; Training Programs; Uganda; Visit; Woman; Work; animation; arm; caregiver education; caregiving; coping; daily functioning; deprivation; early childhood; effective intervention; evidence base; executive function; improved; mortality; neurodevelopment; neuropsychological; nutrition; nutrition education; pediatric human immunodeficiency virus; psychologic; psychosocial; social; standard care; treatment adherence; treatment as usual; vigilance

DESCRIPTION (provided by applicant): Background. Children up to the age of 5 years affected by HIV are the most vulnerable subgroup of HIV populations globally, especially in low-resource areas. This is because of the strategic, volatile, and vulnerable nature of this highly sensitive period of child development. Mediational intervention for sensitizing caregivers (MISC) has a structured training program to enable caregivers to improve their children's cognitive and social development during everyday casual interactions in the home. In our preliminary NIMH R34 findings, Ugandan HIV children of caregivers receiving MISC training biweekly for a year showed significantly greater gains on the Mullen Early Learning Scales Composite of g fluid intelligence, when compared to children whose caregivers received a standard health/nutrition education intervention (treatment as usual or TAU). The MISC caregivers were also significantly less depressed, and their child mortality that year was significantly lower. Intervention Method. One hundred Ugandan HIV-positive preschool and 200 HIV orphan caregiver/child dyads will be enlisted from Kayunga and Pallisa Districts. These dyads will be randomly assigned by village clusters to either biweekly MISC or health/nutrition education TAU intervention for one year. Child Outcomes are the child development gains on the Mullen, the Early Childhood Vigilance Test (ECVT) of attention, and the Color- Object Association Test (COAT) of memory, the Behavior Rating Inventory of Executive Functioning - Preschool (BRIEF-P), and the caregiver administered version of the Achenbach CBCL. Caregiver Outcomes include an array of emotional wellbeing (EWB) and daily functioning measures validated during the initial qualitative study phase. Study Aim 1 will evaluate if MISC significantly enhances child outcomes when compared to controls for both HIV-positive and orphan children when assessed from baseline to 6, 12, and 18 months. Study Aim 2 will evaluate if MISC significantly enhances caregiver EWB and daily functioning outcomes. To better understand the mechanisms of MISC-enhanced child development, a Secondary Aim is to evaluate the mediating effect of improved caregiver EWB outcomes on corresponding child development gains, and the modifying effects of caregiver HIV illness and functioning on child outcomes. The Overall Impact comes from establishing the feasibility, acceptability, and effectiveness of MISC for HIV orphans and vulnerable children (OVC) and their caregivers in low resource settings; the sustainability of MISC in low resource settings since it is not dependent on published materials or outside resources; the complementary dual impact of significant psychotherapeutic benefit for the caregiver, especially mothers struggling with HIV disease. MISC will also reduce HIV child mortality because in our initial R34 findings, MISC heightened maternal bonding, sensitivity to serious illness, and the prompter seeking of medical care. It also can improve treatment adherence. Finally, our evidence-based MISC caregiver training interventions can be readily implemented globally as a sustainable way to augment OVC cognitive, psychosocial, and medical wellbeing. PUBLIC HEALTH RELEVANCE: Early childhood (up to age 5 yrs) is a period of dramatic change in the cognitive, emotional, social, and behavioral domains; children continuously progress by observing and interacting with the world around them. In the face of economic instability and nutritional, medical and educational deprivation, HIV-affected very young children are the most vulnerable HIV subgroup globally because their families are often the most vulnerable, with little margin for sustaining a favorable developmental milieu for the child. Through strategic caregiver interventions during this sensitive period of child neurodevelopment, our study findings have the potential for positively re-directing the developmental trajectories of tens of millions of HIV-affected children globally.

描述（由申请人提供）：背景。受艾滋病毒影响的5岁以下儿童是全球艾滋病毒感染人口中最脆弱的亚群，特别是在资源匮乏地区。这是因为儿童发展的这一高度敏感时期具有战略性、易变性和脆弱性。提高照顾者敏感性的中介干预有一个结构化的培训方案，使照顾者能够在家中的日常随意互动中改善其子女的认知和社会发展。在我们的初步NIMH R34研究结果中，乌干达艾滋病毒儿童的照顾者接受MISC培训，每两周一次，为期一年，显示出显着更大的增益在马伦早期学习量表复合g流体智力，相比儿童的照顾者接受标准的健康/营养教育干预（治疗照常或TAU）。MISC照顾者的抑郁程度也明显降低，当年他们的儿童死亡率也明显降低。干预方法。将从卡永加和Pallisa区招募100名乌干达艾滋病毒阳性学龄前儿童和200名艾滋病毒孤儿照顾者/儿童。这些二人组将由村庄分组随机分配到每两周一次的MISC或健康/营养教育TAU干预，为期一年。儿童结局是儿童在马伦、注意力的早期儿童警觉性测试（ECVT）、记忆的颜色-物体联想测试（COAT）、执行功能行为评定量表-学龄前（BRIEF-P）和照顾者管理的Achenbach CBCL版本上的发展增益。照顾者的结果包括一系列的情绪健康（EWB）和日常功能的措施，在最初的定性研究阶段验证。研究目的1将评估MISC与对照组相比，从基线至6、12和18个月评估时，HIV阳性儿童和孤儿的儿童结局是否显著改善。研究目标2将评价MISC是否显著增强护理者EWB和日常功能结局。为了更好地了解MISC增强儿童发展的机制，次要目的是评估改善照顾者EWB结果对相应儿童发展收益的中介作用，以及照顾者艾滋病毒疾病和功能对儿童结果的修饰作用。总体影响来自于确定MISC在低资源环境中对艾滋病毒孤儿和弱势儿童及其照顾者的可行性、可接受性和有效性; MISC在低资源环境中的可持续性，因为它不依赖于出版材料或外部资源;对照顾者，特别是与艾滋病毒疾病作斗争的母亲的重要心理治疗益处的补充双重影响。MISC还将降低艾滋病毒儿童死亡率，因为在我们最初的R34调查结果中，MISC增强了母亲的联系，对严重疾病的敏感性，以及更快地寻求医疗保健。它还可以提高治疗依从性。最后，我们基于证据的MISC护理人员培训干预措施可以在全球范围内实施，作为增强OVC认知，心理社会和医疗健康的可持续方式。 公共卫生相关性：幼儿期（5岁以下）是认知、情感、社会和行为领域发生巨大变化的时期;儿童通过观察和与周围世界互动而不断进步。在经济不稳定和营养、医疗和教育匮乏的情况下，受艾滋病毒影响的幼儿是全球最脆弱的艾滋病毒亚群，因为他们的家庭往往是最脆弱的，几乎没有余地为儿童维持有利的发展环境。通过在儿童神经发育的敏感时期进行战略性护理干预，我们的研究结果有可能积极地重新引导全球数千万受艾滋病毒影响的儿童的发展轨迹。