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人群中最脆弱的亚群体，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。对敏感照顾者的调解干预（MISC）有一个结构化的培训计划，使照顾者能够在日常家庭互动中改善孩子的认知和社会发展。在我们初步的NIMH R34研究结果中，与接受标准健康/营养教育干预（常规治疗或TAU）的儿童相比，护理人员每两周接受MISC培训一年的乌干达艾滋病毒儿童在马伦早期学习量表（Mullen Early Learning Scales Composite）上的智力显著提高。MISC照顾者的抑郁程度也显著降低，他们当年的儿童死亡率也显著降低。干预方法。将从卡永加区和帕利萨区招募100名乌干达艾滋病毒阳性学龄前儿童和200名艾滋病毒孤儿照料者/儿童。这些二人组将被随机分配到每两周一次的MISC或健康/营养教育TAU干预中，为期一年。儿童结果是儿童在马伦、幼儿注意警惕性测试（ECVT）、记忆的颜色-物体关联测试（COAT）、学前执行功能行为评定量表（BRIEF-P）和照顾者管理的Achenbach CBCL版本上的发展收益。护理结果包括一系列情绪健康（EWB）和日常功能测量，在最初的定性研究阶段得到验证。研究目标1将评估从基线到6、12和18个月时，与对照组相比，MISC是否显著提高了艾滋病毒阳性儿童和孤儿的预后。研究目标2将评估MISC是否显著提高照顾者EWB和日常功能结果。为了更好地理解misc促进儿童发展的机制，第二个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HIV疾病和功能对儿童结果的调节作用。总体影响来自于在低资源环境中为艾滋病毒孤儿和弱势儿童（OVC）及其照顾者建立MISC的可行性、可接受性和有效性；在资源匮乏的情况下，MISC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，特别是与艾滋病毒作斗争的母亲来说，显著的心理治疗益处的互补双重影响。MISC还将降低艾滋病毒儿童死亡率，因为在我们最初的R34研究结果中，MISC提高了母亲的联系，对严重疾病的敏感性，并促使寻求医疗保健。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很容易地在全球范围内实施，作为一种可持续的方式来增强OVC的认知、心理社会和医疗健康。