2/2-Maternal HIV: Multisite Trial to Assist Disclosure to Children

2/2-孕产妇艾滋病毒：多中心试验以协助向儿童披露

• 批准号: 8543760
• 负责人: LISA P ARMISTEAD
• 金额: $ 20.24万
• 依托单位: GEORGIA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-11 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8543760
• 关键词: 14 year old; AIDS/HIV problem; Acting Out; African American; Age; Anxiety; Area; Behavior; Characteristics; Charge; Child; Child Development; Child Mental Health; Communities; Control Groups; Country; County; Demographic Factors; Development; Disclosure; Educational Intervention; Educational process of instructing; Emotional; Epidemic; Ethnic Origin; Family; Fright; Gender; HIV; HIV Seropositivity; Individual; Intervention; Intervention Studies; Intervention Trial; Interview; Interviewer; Joints; Knowledge; Latina; Life; Los Angeles; Mediating; Mental Depression; Mental Health; Mothers; NIH Program Announcements; Online Systems; Outcome; Parents; Pilot Projects; Prevention; Protocols documentation; Quality of life; Race; Randomized; Research; Role; Sample Size; Sampling; Secondary Prevention; Self Efficacy; Severity of illness; Site; Time; Treatment Efficacy; Woman; Work; base; cohesion; data management; design; efficacy testing; follow-up; group intervention; improved; longitudinal design; medication compliance; meetings; pilot trial; prevent; quality assurance; satisfaction; social stigma; theories; therapy development

DESCRIPTION (provided by applicant): The purpose of this Collaborative R01, under Program Announcement PAR-09-153, is to conduct a full-scale trial of an intervention to assist mothers living with HIV (MLH) with disclosing their serostatus to their young (age 6 - 14 year old), well children. A pilot study of the intervention has recently been completed (R01 MH077493) and met its major aims. The basis for development of the pilot intervention was work from three R01s (MH057207, currently Yr. 14) designed to longitudinally assess MLH and their children. Within that work, several studies were conducted on maternal disclosure (e.g., Murphy, Marelich, & Hoffman, 2002; Murphy, Roberts, & Hoffman, 2002; Murphy, Roberts, & Hoffman, 2003; Murphy, Roberts, & Hoffman, 2006; Murphy, Steers, & Dello Stritto, 2001), suggesting disclosure is difficult, and outcomes for MLH and children could be improved by intervention. The pilot study, known in the community as Teaching, Raising, And Communicating with Kids (TRACK), was based on integrative disclosure theory (Derlega et al., 2004). Results of the pilot trial indicate that those in the intervention group were six times more likely to disclose their HIV/AIDS status to their child than those in the control group (O.R. 6.33) by the 9-month follow-up 33% of intervention MLH disclosed, compared to only 7.3% of the control group. Perhaps more importantly, the intervention group's emotional functioning and their satisfaction improved significantly following the intervention, compared to the control group Similarly, child mental health indicators among children of intervention MLH were significantly better than control group children at follow-ups. In this study, TRACK II, we propose to conduct a full-scale trial of the intervention in two sites: (1) Los Angeles county (Site 1, where the pilo trial was conducted), which will include a high proportion of Latina families and a smaller proportion of African-American and White families; and (2) Atlanta, Georgia (Site 2, where the primary consultant on the pilot trial conducts research), which will include a high proportion of Southern African-American families, as well as White families. MLH and their children (N = 440 total; 110 mothers and 110 children per site, n = 220 per site) will be assessed at baseline and at 3, 9, and 15-month follow-ups. MLH will be randomly assigned to the intervention or control. Aims are to: 1. facilitate disclosure of the mothers' HIV status to the children, which will includ secondary aims of: a. increasing mothers' self-efficacy to disclose and respond to child questions regarding HIV; b. reducing mothers' fears regarding disclosure and stigma; c. improving maternal knowledge of child development and how to provide appropriate levels of information given the age of the child; 2. improve MLH mental health indicators over time (i.e., depression, anxiety, quality of life); 3. improve child mental health indicators over time (i.e., depression, anxiety, acting out behaviors); and 4. improve family functioning indicators (e.g., cohesion, perceived closeness between mother and child).

描述(由申请人提供)：根据计划公告PAR-09-153，本协作R01的目的是进行一项干预措施的全面试验，以帮助感染艾滋病毒(MLH)的母亲向其年幼(6-14岁)、健康的孩子披露其血清状态。干预的初步研究最近已经完成(R01MH077493)，并达到了主要目标。试点干预措施的开发基础是从三个R01(MH057207，目前是年。14)旨在纵向评估MLH及其子女。在这项工作中，进行了几项关于母亲披露的研究(例如，Murphy，Marelich，&Hoffman，2002；Murphy，Roberts，&Hoffman，2002；Murphy，Roberts，&Hoffman，2003；Murphy，Roberts，&Hoffman，2006；Murphy，Steers，&Dello Stritto，2001)，表明披露是困难的，MLH和儿童的结果可以通过干预得到改善。这项试点研究在社区中被称为教学、抚养和与儿童沟通(TRACE)，是基于综合披露理论(Derlega等人，2004年)。试点试验的结果表明，干预组的发病率是对照组的6倍以上。 在9个月的随访期内，MLH披露的33%的干预措施中，有可能向孩子披露自己的艾滋病毒/艾滋病状况的比例高于对照组(O.R.6.33)，而对照组的这一比例仅为7.3%。也许更重要的是，干预后干预组儿童的情绪功能及其满意度显著提高，与对照组相比，MLH干预组儿童的心理健康指标在随访时显著优于对照组儿童。在这项名为Track II的研究中，我们建议在两个地点进行一次全面的干预试验：(1)洛杉矶县(地点1，进行Pilo试验)，其中将包括高比例的拉丁裔家庭，以及较小比例的非裔美国人和白人家庭；(2)佐治亚州亚特兰大(地点2，试点试验的主要顾问进行研究)，其中将包括比例较高的南部非洲裔家庭和白人家庭。MLH及其子女(共440人；每个地点110名母亲和110名儿童，每个地点n=220人)将在基线以及3、9和15个月的随访时进行评估。MLH将被随机分配到干预或对照中。目的是：1.促进向儿童披露母亲的艾滋病毒状况，这将包括以下次要目标：a.提高母亲的自我效能，以披露和回应有关艾滋病毒的儿童问题；b.减少母亲对披露和羞辱的恐惧；c.提高母亲对儿童发展的知识，以及如何根据孩子的年龄提供适当水平的信息；2.随着时间的推移改善MLH精神健康指标(即抑郁、焦虑、生活质量)；3.随着时间的推移改善儿童精神健康指标(即抑郁、焦虑、行为不端)；4.改善家庭功能指标(例如，亲密度、母子之间的亲密感)。