Comparative effectiveness of pediatric HIV disclosure interventions in Uganda

乌干达儿童艾滋病毒披露干预措施的比较效果

• 批准号: 8870398
• 负责人: Lisa Michelle Butler
• 金额: $ 20.65万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8870398
• 关键词: 12 year old; 15 year old; Acquired Immunodeficiency Syndrome; Adolescence; Adverse effects; Africa; Africa South of the Sahara; Age; Anxiety; Area; Attenuated; Behavior; Behavioral; Caregivers; Caring; Characteristics; Child; Child Mental Health; Child health care; Chronic Disease; Clinic; Clinical; Cognitive; Cognitive Therapy; Communication; Country; Direct Costs; Disclosure; Disease; Education; Educational Background; Effectiveness; Effectiveness of Interventions; Emergency Situation; Emotional; Enrollment; Event; Expectancy; Funding; Guidelines; HIV; HIV diagnosis; Health; Health Care Costs; Health Personnel; International; Intervention; Lead; Learning; Life; Measures; Mediating; Medical; Mental Depression; Mental Health; Modeling; Motivation; Outcome; Policies; Population; Problem behavior; Process; Professional counselor; Quasi-experiment; Randomized Controlled Trials; Recommendation; Research; Schedule; Self Efficacy; Services; Techniques; Testing; Training; Translating; Uganda; antiretroviral therapy; burden of illness; caregiver education; child depression; cognitive development; comparative effectiveness; coping; cost; cost effective; cost effectiveness; design; development policy; disability weights; disability-adjusted life years; experience; improved; innovation; intervention effect; meetings; member; pediatric human immunodeficiency virus; programs; response; scale up; skills; social cognitive theory; standard care; treatment program

DESCRIPTION (provided by applicant): At the end of 2009, there were an estimated 2.1 million children under the age of 15 years living with HIV, with almost 90% residing in sub-Saharan Africa (SSA). With increased availability of antiretroviral therapy (ART) and improved care, increasing numbers of perinatally infected children are surviving into adolescence. There are an estimated 150,000 HIV-infected children in Uganda. While HIV care and treatment programs for children are expanding, a growing challenge facing health providers and caregivers is disclosure of HIV serostatus to infected children. Studies conducted in SSA have indicated that only 2% to 37.8% of HIV-infected children < 15 years know their HIV status. In Uganda, despite the rapid expansion of HIV services for children, very few health providers receive formal training in how to support disclosure of an HIV diagnosis to an infected child. As HIV care and treatment programs for children are scaled up to meet the demand of a growing population of HIV-infected children in SSA, there is an urgent need for effective, cost-effective, culturally appropriate, and scalable disclosure interventions that improve caregivers ability to communicate with their child about chronic illness and HIV, and promote sustained positive mental health, behavioral and clinical outcomes of HIV-infected children who learn their HIV status. We propose a 4-year project to test the effectiveness of a cognitive-behavioral intervention that we have designed to support developmentally appropriate disclosure to HIV-infected children by their caregiver. The intervention is informed by social cognitive theory and the information-motivation-behavior model, and would adapt components of a multi- faceted program for caregivers of HIV-infected children, developed by members of our team with funding support from the US President's Emergency Plan for AIDS Relief (PEPFAR). Our specific aims are: AIM 1: To determine the effectiveness of a cognitive-behavior intervention for increasing disclosure of children's HIV diagnosis by caregivers to their HIV-infected children age 7-12 years old in Uganda. We will evaluate the intervention using a stepped wedge quasi-experiment implemented at four Kampala area HIV clinics, with a total of 400 caregiver-child dyads, and followed for 24 months. We hypothesize that the enhanced intervention will lead to increased disclosure rates. We will compare disclosure among caregiver- child dyads enrolled in the intervention and dyads enrolled in standard care guided by Uganda National guidelines for HIV Care and Treatment. AIM 2: To determine the effect of disclosure on immediate and longer- term caregiver and child mental health, and child behavioral and clinical outcomes, and whether the intervention modifies these effects. We hypothesize that the intervention will attenuate potential adverse effects of disclosure, including depression, anxiety, and behavioral problems. AIM 3: To assess the incremental cost, and cost-effectiveness of the intervention. The findings of this study will inform Ugandan and other countries national policies on pediatric HIV care and treatment.

描述（由申请人提供）：截至2009年底，估计有210万15岁以下儿童感染艾滋病毒，其中近90%居住在撒哈拉以南非洲（SSA）。随着抗逆转录病毒疗法（ART）的普及和护理的改善，越来越多的围产期感染儿童存活到青春期。乌干达估计有15万名感染艾滋病毒的儿童。虽然儿童艾滋病毒护理和治疗方案正在扩大，但保健提供者和照顾者面临的一个日益严峻的挑战是向受感染儿童披露艾滋病毒血清状况。在SSA进行的研究表明，15岁以下感染艾滋病毒的儿童中，只有2%至37.8%知道自己的艾滋病毒感染状况。在乌干达，尽管针对儿童的艾滋病毒服务迅速扩大，但很少有保健提供者在如何支持向受感染儿童披露艾滋病毒诊断方面接受过正式培训。随着儿童艾滋病毒护理和治疗方案的扩大，以满足SSA不断增长的艾滋病毒感染儿童人口的需求，迫切需要有效的、具有成本效益的、文化上合适的、可扩展的披露干预措施，以提高护理人员与儿童就慢性疾病和艾滋病毒进行沟通的能力，并促进艾滋病毒感染儿童在了解其艾滋病毒状况后的持续积极的心理健康、行为和临床结果。我们提出了一个为期4年的项目，以测试我们设计的认知行为干预的有效性，该干预旨在支持照顾者向感染艾滋病毒的儿童披露符合发育要求的信息。这项干预是根据社会认知理论和信息-动机-行为模型进行的，并将适应我们团队成员在美国总统艾滋病紧急救援计划（PEPFAR）的资助下为艾滋病毒感染儿童护理人员制定的多方面计划的组成部分。我们的具体目标是：目标1：确定认知行为干预的有效性，以增加乌干达7-12岁艾滋病毒感染儿童的护理人员对儿童艾滋病毒诊断的披露。我们将在坎帕拉地区的四家艾滋病毒诊所对400名照顾者-儿童夫妇进行为期24个月的阶梯式楔形准实验，以评估干预措施。我们假设，加强干预将导致增加的披露率。我们将比较参加干预的照顾者-儿童夫妇和参加由乌干达国家艾滋病毒护理和治疗指南指导的标准护理的照顾者-儿童夫妇之间的信息披露情况。目的2：确定披露对即时和长期照顾者和儿童心理健康的影响，以及儿童行为和临床结局的影响，以及干预是否会改变这些影响。我们假设，干预将减轻潜在的不利影响披露，包括抑郁，焦虑，和行为问题。目标3：评估干预措施的增量成本和成本效益。这项研究的结果将为乌干达和其他国家儿科艾滋病毒护理和治疗的国家政策提供信息。