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况在全世界都是一项挑战。护理人员和卫生保健提供者都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成功的干预措施。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，卫生和社会服务部和国际卫生培训和教育中心（I-TECH）合作为照料者和卫生保健工作者制定和实施了一项创新的、结构化的信息披露干预措施。该方案包括一本与文化相关、对儿童友好的书，书中使用彩色卡通图画协助卫生保健工作者分阶段披露艾滋病毒状况；一种工具，帮助卫生保健工作者评估照料者和儿童是否准备好全面披露艾滋病毒，并系统地克服障碍；长期监测儿童对其疾病认识的工具；还有一个培训课程，让医护人员团队在他们的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护理人员和卫生保健工作者，促进健康的披露过程，从而提高儿童对其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)评估儿童信息披露干预措施在纳米比亚9个儿科患者数量最多的地区的实施保真度；(2)比较参与和未参与披露项目的患儿的预后；(3)通过访谈和调查来确定披露计划对卫生保健工作者的好处，即通过披露增加他们的知识和信心（自我效能感）；(4)通过访谈确定披露计划对护理人员的好处，以提高他们照顾和支持艾滋病毒感染儿童的能力（包括坚持服药）。如果证明是成功的，这种干预措施依赖于相对低成本和当地生产的工具，并且所有卫生保健工作者只需经过最少的培训就可以使用，这一事实可能使其对撒哈拉以南非洲其他地方的复制特别有吸引力。因此，对小儿的潜在影响

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.