Evaluation of an Intervention to Support HIV Disclosure to Children in Namibia

描述（由申请人提供）：向儿童披露艾滋病毒状况有可能支持他们的心理健康，并提高他们对抗逆转录病毒药物的依从性。然而，向儿童披露艾滋病毒呈阳性的情况是全世界面临的一个挑战。护理人员和卫生保健提供者经常感到没有准备好参与这种困难的对话。虽然有一些文献描述了向儿童披露信息的挑战，并建议开发和评估支持这一进程的资源，但没有详细描述或评估撒哈拉以南非洲的成功干预措施。在纳米比亚，有9 000多名儿童正在接受艾滋病毒抗逆转录病毒治疗，卫生和社会服务部与国际卫生培训和教育中心合作，为照顾者和保健工作者制定和实施创新的、结构化的披露干预措施。该方案包括一本与文化相关的儿童友好书籍，其中使用彩色卡通画协助保健工作者分阶段披露艾滋病毒状况;一个工具，帮助保健工作者评估照顾者和儿童对全面披露艾滋病毒状况的准备情况，并系统地克服障碍;一个工具，监测儿童对自己疾病的了解情况;以及一个培训课程，使卫生保健工作者小组能够在其工作地点使用这本书和工具。我们假设，这种多管齐下的干预措施将支持照顾者和卫生保健工作者，促进健康的披露过程，从而提高儿童对艾滋病毒疾病的理解和管理。I-TECH建议通过以下四个目标来评估这一干预措施：（1）评估纳米比亚九个儿科患者数量最多的地点实施儿童披露干预措施的忠实性;（2）比较参与披露方案的儿童与未参与方案的儿童之间的患者结局;（3）使用访谈和调查来确定信息披露计划在增加医护人员的知识和信心方面对他们的好处（自我效能）与披露;（4）使用访谈，以确定披露计划的好处，照顾者在提高他们的能力，照顾和支持艾滋病毒感染儿童（包括坚持服药）。如果证明是成功的，这种干预措施依赖于成本相对较低和当地生产的工具，而且所有保健工作者只需接受最低限度的培训就可以使用，这一事实可能使其特别吸引撒哈拉以南非洲其他地区的复制。因此，对儿童的潜在影响 患者健康、护理人员和卫生保健工作者都很好。 公共卫生相关性：虽然有很多证据表明需要对儿童艾滋病毒进行披露干预，但成功的方案几乎没有证据基础。拟议在纳米比亚进行的关于当地开发的、文化上适当的和可持续的儿童披露干预措施的评价研究的结果可能在纳米比亚和撒哈拉以南非洲其他地区对卫生保健工作者和护理人员披露自我效能以及儿科临床结局产生广泛影响

DESCRIPTION (provided by applicant): Disclosing HIV status to children has the potential to support their psychological health and improve their adherence to antiretroviral medications. However, disclosing an HIV positive status to children is a challenge worldwide. Both caregivers and health care providers often feel unprepared to engage in this difficult conversation. Although there is some literature describing the challenges of disclosure to children, and recommending the development and evaluation of resources to support this process, there are no detailed descriptions or evaluations of successful interventions in sub-Saharan Africa. In Namibia, where more than 9,000 children are on antiretroviral treatment for HIV, the Ministry of Health and Social Services and the International Training and Education Center for Health (I-TECH) have collaborated to develop and implement an innovative, structured disclosure intervention for caregivers and health care workers. The program includes a culturally relevant, child-friendly book, which uses colorful cartoon drawings to assist health care workers in a staged procedure for disclosing HIV status; a tool to help health care workers assess caregiver and child readiness for full HIV disclosure and to systematically work through barriers; a tool to monitor children's understanding of their disease over time; and a training curriculum to prepare teams of health care workers to use the book and tools at their sites. We hypothesize that this multipronged intervention will support caregivers and health care workers and facilitate a healthy disclosure process, thus improving children's understanding and management of their HIV disease. I-TECH proposes to evaluate this intervention through the following four aims: (1) Assess the implementation fidelity of the child disclosure intervention at the nine highest pediatric patient volume sites in Namibia; (2) compare patient outcomes between children who are in the disclosure program and those who are not in the program; (3) use interviews and surveys to determine the benefits of the disclosure program to health care workers in increasing their knowledge and confidence (self-efficacy) with disclosure; and (4) use interviews to determine the benefits of the disclosure program to caregivers in improving their ability to care for and support children living with HIV (including adherence to medications). If shown to be successful, the fact that the intervention relies on relatively low-cost and locally produced tools and that it can be used with minimal training by all health care workers, could make it especially attractive for replication elsewhere in sub-Saharan Africa. Thus, the potential impact on pediatric patient health, caregivers, and health care workers is great. Public Health Relevance: Although there is much evidence of the need for child HIV disclosure interventions, there is little evidence base for successful programs. Findings from the proposed evaluation study in Namibia, of a locally developed, culturally appropriate, and sustainable child disclosure intervention, could have broad impact in Namibia and elsewhere in sub-Saharan Africa in terms of health care worker and caregiver self-efficacy for disclosure, as well as pediatric clinical outcomes