A bioecological pediatric HIV disclosure intervention in Ghana -

加纳的生物生态儿童艾滋病毒披露干预措施 -

• 批准号: 8697078
• 负责人: ELIJAH PAINTSIL
• 金额: $ 35.39万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8697078
• 关键词: Adherence; Adolescence; Adult; Africa South of the Sahara; Age; Area; Automobile Driving; Back; Behavioral; Birth; Caregivers; Caring; Characteristics; Child; Child Welfare; Child health care; Childhood; Clinic; Clinical; Communities; Control Groups; Counseling; Country; Developing Countries; Diagnosis; Disclosure; Elements; Enrollment; Family; Ghana; HIV; HIV diagnosis; Health; Health Personnel; Healthcare; Home environment; Human Resources; Immunologics; Income; Intervention; Investigation; Knowledge; Lead; Life; Modeling; Motivation; Outcome; Participant; Phase; Process; Provider; Psychological adjustment; Randomized; Recommendation; Research; Resources; Rights; Risk; Role; Severity of illness; Social Welfare; Specialist; Structure; Systems Theory; Testing; Time; Training; Translating; Work; antiretroviral therapy; expectation; follow-up; group intervention; improved; medical specialties; medication compliance; patient oriented; pediatric human immunodeficiency virus; prevent; psychosocial; public health relevance; randomized trial; response; scale up; sexually active; skills; sound; transmission process; treatment as usual

DESCRIPTION (provided by applicant): The project aims to provide information on a structured disclosure intervention that can be integrated into usual care in Ghana and other resource-limited settings to improve the welfare of HIV-infected children and their caregivers. This area of investigation is profoundly understudied and of high importance to millions of children and their families in sub-Saharan Africa. While widely recognized as vital to better health outcomes, especially in the era of better access to HIV treatment, many children are not informed of their HIV diagnosis. A variety of sociocultural contextual barriers and deficient skill drive the persistent reluctance of caregivers and health care providers to inform children of the diagnosis. Our preliminary work shows that several key factors can be modified and the process of disclosure promoted with an intervention approach that is grounded in a traditional Ghanaian concept, "SANKOFA", and behavioral and bioecological systems theory. The patient-centered intervention approach uses an Adherence and Disclosure specialist model where a designated specialist familiar with the socio-cultural norms of the community is well trained to target modifiable information, motivation and behavioral skills of caregivers to facilitate their engagement in the process of disclosure (i.e., pre-disclosure, disclosure, and post-disclosure phases) in a manner suitable to the needs of the child. The primary aims are: (1) To evaluate the effect of a structured, culturally-relevant disclosure intervention to caregivers delivered by specialist as an integral component of routine HIV healthcare on the rate of caregiver disclosure of pediatric HIV at 1 year follow-up compared to treatment as usual, control condition, in a randomized trial and (2) To identify baseline characteristics (e.g., caregiver knowledge & motivation, child's age) predictive of caregiver disclosure of pediatric HIV independent of and in the presence of the structured disclosure intervention at 1 year follow-up. Secondary aims are: (3) To assess whether the effect of HIV pediatric disclosure on medication adherence and health outcomes of children (virologic, immunologic, psychosocial, and behavioral) and the caregiver (psychosocial) varies by exposure vs. non-exposure to the structured disclosure intervention and (4) To assess the fidelity and acceptability of the disclosure intervention over time among the clinic personnel designated disclosure specialist, caregiver, and children to whom HIV status has been disclosed. Provider, caregiver and child participants will be enrolled from tertiary HIV clinics in Ghana with longitudinal outcomes evaluated every 3 months post-randomization to 24 months post disclosure. Public Health Relevance: A culturally-relevant, theoretically and empirically sound, patient-centered, standardized disclosure intervention that can be integrated into routine clinical pediatric HIV care has potential to prevent transmission and improve the welfare of children and their caregivers in Ghana and other resource-limited settings. Results from this project will also further an understanding of factors and processes driving pediatric HIV disclosure. Public

描述（由申请人提供）：该项目旨在提供有关结构化披露干预措施的信息，该干预措施可以纳入加纳和其他资源有限环境的常规护理中，以改善艾滋病毒感染儿童及其照顾者的福利。这一调查领域的研究还很不够，对于撒哈拉以南非洲数百万儿童及其家庭来说非常重要。虽然人们普遍认为这对改善健康结果至关重要，尤其是在更好地获得艾滋病毒治疗的时代，但许多儿童并不知道自己的艾滋病毒诊断结果。各种社会文化背景障碍和技能不足导致护理人员和医疗保健提供者始终不愿告知儿童诊断结果。我们的初步工作表明，可以通过基于加纳传统概念“SANKOFA”以及行为和生物生态系统理论的干预方法来修改几个关键因素并促进披露过程。以患者为中心的干预方法采用依从性和披露专家模型，其中熟悉社区社会文化规范的指定专家经过良好培训，以护理人员的可修改信息、动机和行为技能为目标，以促进他们以适合儿童需求的方式参与披露过程（即披露前、披露和披露后阶段）。主要目的是：(1) 在一项随机试验中，评估由专家向护理人员提供的结构化、文化相关的披露干预措施作为常规 HIV 医疗保健的一个组成部分，与照常治疗、对照条件相比，对护理人员在 1 年随访时披露儿科 HIV 的比率的影响；(2) 确定基线特征（例如，护理人员知识和动机、儿童年龄）预测 在 1 年随访时，独立于结构化披露干预且存在结构化披露干预的情况下，护理人员披露儿科 HIV 的情况。次要目标是：(3) 评估 HIV 儿科披露对儿童（病毒学、免疫学、社会心理和行为）和护理人员（社会心理）的药物依从性和健康结果的影响是否因接触与未接触结构性披露干预而有所不同，以及 (4) 评估指定披露的临床人员随时间推移披露干预的保真度和可接受性 已向其披露艾滋病毒感染状况的专家、护理人员和儿童。提供者、看护者和儿童参与者将从加纳的三级艾滋病毒诊所招募，并在随机分组后每 3 个月至披露后 24 个月对纵向结果进行评估。 公共卫生相关性：一种与文化相关、理论上和经验上合理、以患者为中心、标准化的披露干预措施，可以纳入常规临床儿科艾滋病毒护理中，有可能预防传播并改善加纳和其他资源有限地区儿童及其护理人员的福利。该项目的结果还将进一步了解推动儿童艾滋病毒披露的因素和过程。民众