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

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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). PUBLIC HEALTH RELEVANCE: The purpose of this Collaborative R01 is to test the efficacy of a full-scale trial of a disclosure intervention for HIV-infected mothers with children age 6 - 14 years of age. The basis for development of this intervention is work from two previous R01s (MH057207, currently Yr. 14) designed to longitudinally assess HIV-positive mothers and their children. From that observational work, a disclosure intervention was developed and a pilot trial of the intervention was conducted. In the pilot study, mothers in the intervention group were more likely to disclose their serostatus to their children, and both mothers and children in the intervention group showed better mental health scores following disclosure than mothers and children assigned to the control condition. We are now in the third decade of the HIV epidemic, and few interventions, other than for prevention or medication adherence, are available for women living with HIV; the longitudinal design and increased sample size of this full scale trial o the intervention will allow us to explore maternal and child characteristics that may moderate or mediate the impact of disclosure (e.g., demographic factors such as age, gender, ethnicity; maternal HIV/AIDS stigma, and illness severity), as well as investigate in more detail the trajectories of children who have been disclosed to versus those who have not.