Disclosure Intervention for Zimbabwean Parents

对津巴布韦家长的披露干预

• 批准号: 8391159
• 负责人: Marguerita A. Lightfoot
• 金额: $ 31.18万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8391159
• 关键词: 17 year old; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adult; Affect; Africa South of the Sahara; Anti-Retroviral Agents; Anxiety; Area; Attention; Behavioral; Cessation of life; Child; Child Custody; Childhood; Country; Developing Countries; Dietary Intervention; Disclosure; Emotional; Environment; Family; Family Relationship; Frequencies; Fright; Guidelines; HIV; HIV Seropositivity; Health Status; Income; International; Intervention; Knowledge; Left; Life; Low income; Medical; Mental Depression; Modeling; Motivation; Nurses; Outcome; Parents; Policies; Population; Prevalence; Problem behavior; Randomized; Randomized Controlled Trials; Reaction; Recommendation; Risk; Risk Behaviors; Social support; South Africa; Stress; Time; Treatment Efficacy; Zimbabwe; affection; aged; base; child depression; cohesion; improved; neglect; nutrition; pediatric human immunodeficiency virus; psychologic; response; social; transmission process; willingness

DESCRIPTION (provided by applicant): We propose a randomized controlled trial of a disclosure intervention in which 300 PLH are randomized to either an: 1) experimental condition, a disclosure intervention (n = 150 parents) or 2) attention control condition, a nutrition intervention (n = 150). The intervention's impact will be assessed over two years (recruitment, 3, 6, 12, 18, & 24 months). The 3-session, culturally tailored disclosure intervention will be delivered by local nurses and address planning for developmentally appropriate disclosure (how and when to disclose), responding to children's reactions, building a supportive family environment, and custody planning. The attention control condition will be relevant to PLH, also delivered by nurses and address nutrition. Therefore, the Specific Aims are to: 1) Primary Aim: Assess the efficacy of the intervention to increase the frequency and timing of parental disclosure. We hypothesize that PLH randomized to the disclosure intervention will be significantly more likely to disclose their own HIV status to their children (parental disclosure) and disclose sooner than PLH randomized to the control condition. 2) Primary Aim: Assess the longitudinal impact of disclosure on parent (medical, psychological, social), child (psychological, behavioral, social) and family outcomes. We hypothesize that parent (health status, depression, anxiety, social support), child (depression, anxiety, HIV-transmission risk behaviors, social support) and family outcomes (family relationships, custody planning) will be significantly better for families in the intervention than families randomized to the control condition. 3) Secondary Aim: Assess the efficacy of the intervention to increase pediatric disclosure. We hypothesize that PLH randomized to the disclosure intervention will be significantly more likely to disclose to a child that s/he is HIV-positive (pediatric disclosure) than PLH randomized to the control condition. The proposed study addresses a neglected and profoundly understudied area that is of high importance to millions of families affected by HIV. If successful, the proposed study will provide evidence for a sustainable model and efficacious disclosure intervention in low-income settings. PUBLIC HEALTH RELEVANCE: Zimbabwe is one of the countries hardest hit by HIV/AIDS, with over 900,000 living children who have lost one or both of their parents to AIDS. Given the growing number of families affected by HIV/AIDS, parents are faced by the challenge of whether, how, and when to disclose their HIV status to their children. The proposed study will significantly contribute to our understanding of disclosure by examining the impact of a culturally competent intervention to facilitate parental HIV disclosure and the subsequent impact of the disclosure on the parent, child and family. If successful, this study would develop an efficacious intervention for vulnerable families and inform current knowledge about the impacts of disclosure in developing countries.

描述（由申请人提供）：我们提出了一项披露干预措施的随机对照试验，其中300 PLH被随机分配给：1）实验条件，披露干预措施（n = 150个父母）或2）注意力控制条件，营养干预（n = 150）。干预措施的影响将在两年内评估（招聘，3、6、12、18和24个月）。当地护士将提供三项裁定的披露干预措施，并为开发适当的披露（如何以及何时披露），对儿童的反应做出反应，建立支持性的家庭环境和监护计划。注意力控制条件将与PLH有关，PLH也由护士提供并解决营养。因此，具体目的是：1）主要目的：评估干预措施增加父母披露的频率和时机的功效。我们假设将PLH随机分配给披露干预措施的可能性更大，将其自己的艾滋病毒状况披露给孩子（父母披露），并且比随机将其披露的PLH更早地披露为控制条件。 2）主要目的：评估披露对父母（医学，心理，社会），孩子（心理学，，， 行为，社会）和家庭成果。我们假设父母（健康状况，抑郁，焦虑，社会支持），儿童（抑郁，焦虑，艾滋病毒 - 传播风险行为，社会支持）和家庭结果（家庭关系，监护计划）对于家庭中的家庭而言，家庭将比随机的家庭中的家庭要好得多。 3）次要目的：评估干预措施增加小儿披露的功效。我们假设将PLH随机分配给披露干预措施将更有可能披露 他/他是HIV阳性的孩子（小儿披露），而PLH则是随机的控制条件。拟议的研究介绍了一个被忽视且深入研究的领域，这对于数百万受艾滋病毒影响的家庭至关重要。如果成功，拟议的研究将为低收入环境中的可持续模型和有效的披露干预提供证据。 公共卫生相关性：津巴布韦是受艾滋病毒/艾滋病最艰难的国家之一，有超过900,000名活着的孩子失去了一个或两个父母的艾滋病。鉴于受艾滋病毒/艾滋病影响的家庭越来越多，父母面临着是否，如何以及何时向子女披露其艾滋病毒状况的挑战。拟议的研究将通过检查文化的影响来大大有助于我们对披露的理解 有能力促进父母艾滋病毒披露的干预措施以及披露对父母，子女和家庭的后续影响。如果成功的话，这项研究将为弱势家庭开发有效的干预措施，并为发展中国家披露的影响提供当前的知识。