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阳性状态在世界范围内是一项挑战。照顾者和医疗保健提供者通常都觉得没有准备好参与这场艰难的对话。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，但没有详细说明或评价撒哈拉以南非洲的成功干预措施。在纳米比亚，有9000多名儿童正在接受艾滋病毒的抗逆转录病毒治疗，卫生和社会服务部与国际卫生培训和教育中心(I-TECH)合作，为照顾者和医护人员制定和实施了一项创新的、结构化的披露干预措施。该计划包括一本与文化相关的、适合儿童的书，这本书使用五颜六色的卡通画来帮助医护人员分阶段披露艾滋病毒状况；一个工具，帮助医护人员评估照顾者和儿童对全面披露艾滋病毒的准备情况，并有系统地克服障碍；一个工具，用于监测儿童随着时间的推移对自己疾病的了解；以及一个培训课程，让医护人员团队准备在他们的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，并促进健康的披露过程，从而改善儿童对他们的艾滋病毒疾病的了解和管理。I-tech建议通过以下四个目标对这项干预措施进行评估：(1)评估纳米比亚九个儿科患者数量最大的地点实施儿童披露干预措施的保真度；(2)比较参加披露计划的儿童和未参加披露计划的儿童的结果；(3)利用访谈和调查确定披露计划对医护人员在增加他们的知识和对披露的信心(自我效能)方面的好处；以及(4)利用访谈确定披露计划对照顾者在提高他们照顾和支持艾滋病毒感染儿童的能力(包括坚持用药)方面的好处。如果被证明是成功的，这种干预依赖于成本相对较低的当地生产的工具，而且所有卫生保健工作者只需最少的培训就可以使用，这一事实可能会使其对撒哈拉以南非洲其他地区的复制特别有吸引力。因此，对儿科的潜在影响 病人健康、护理人员和医护人员都很棒。 公共卫生相关性：尽管有很多证据表明有必要对儿童艾滋病病毒进行披露干预，但成功项目的证据基础很少。在纳米比亚进行的拟议评估研究的结果，即当地发展的、文化上合适的和可持续的儿童信息披露干预措施，可能会在纳米比亚和撒哈拉以南非洲其他地区的卫生保健工作者和照顾者披露自我效能以及儿科临床结果方面产生广泛影响。

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