Enhancing Ugandan HIV-Affected Child Development with Caregiver Training

简介(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群体，特别是在资源匮乏的地区。这是因为这一高度敏感的儿童发展时期具有战略性、变化性和脆弱性。敏化照料者的调解干预(MISC)有一个系统的培训计划，使照顾者能够在日常的家庭随意互动中改善他们孩子的认知和社交发展。在我们的NIMH R34初步研究结果中，接受MISC为期一年两周培训的乌干达艾滋病毒儿童在马伦早期学习量表g液体智力综合量表上比接受标准健康/营养教育干预(照常治疗或TAU)的儿童在马伦早期学习量表中表现出显著更大的进步。MISC的照顾者也明显不那么抑郁，他们那一年的儿童死亡率明显较低。干预方法。将从卡云加和帕利萨地区招募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/儿童夫妇。这些双胞胎将由村庄小组随机分配到两周一次的MISC或健康/营养教育TAU干预行动中，为期一年。儿童结果是在马伦测验上获得的儿童发展成果，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-学前班的行为评定量表(Brief-P)，以及照顾者管理的Achenbach CBCL版本。护理者的结果包括一系列情绪幸福感(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将评估从基线评估到6个月、12个月和18个月时，与艾滋病毒阳性儿童和孤儿对照相比，MISC是否显著改善儿童结局。研究目标2将评估MISC是否显著提高照顾者的EWB和日常功能结果。为了更好地了解MISC促进儿童发展的机制，第二个目标是评估照料者EWB结果改善对相应的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改效果。总体影响来自于确定在低资源环境下为艾滋病毒孤儿和弱势儿童(OVC)及其照料者提供MISC的可行性、可接受性和有效性；MISC在低资源环境下的可持续性，因为它不依赖出版的材料或外部资源；为照顾者，特别是患有艾滋病毒的母亲提供重大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发现中，MISC增强了母亲的纽带，对严重疾病的敏感性，以及促进寻求医疗护理。它还可以提高治疗依从性。最后，我们基于证据的MISC照顾者培训干预措施可以作为一种可持续的方式在全球范围内实施，以增强OVC的认知、心理和医疗健康。

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.