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 -

基本信息

批准号：
9081619
负责人：
ELIJAH PAINTSIL
金额：
$ 35.44万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-01 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9081619
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 Developing Countries Diagnosis Disclosure Elements Enrollment Family Ghana HIV HIV diagnosis Health Health Personnel Healthcare Home environment Human Resources Immunologics 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 low and middle-income countries medical specialties medication compliance patient oriented pediatric human immunodeficiency virus prevent psychosocial randomized trial response scale up sexually active skills sound transmission process treatment as usual

项目摘要

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.

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，该信息可以集成到加纳和其他资源有限的设置中，以改善感染HIV感染的儿童及其照料者的福利。这一调查领域对撒哈拉以南非洲的数百万儿童及其家人进行了深入研究，并且非常重要。虽然被广泛认为对更好的健康结果至关重要，尤其是在更好地获得艾滋病毒治疗的时代，但许多儿童没有被告知他们的艾滋病毒诊断。各种各样的社会文化背景障碍和技巧不足驱使护理人员和医疗保健提供者不愿告知儿童诊断。我们的初步工作表明，可以修改几个关键因素，并以一种以传统的加纳概念为“ sankofa”以及行为和生物生物学系统理论的干预方法来促进披露过程。以患者为中心的干预方法采用了依从性和披露专家模型，在该模型中，熟悉社区社会文化规范的指定专家经过了良好的培训，可以针对护理人员的可修改信息，动机和行为技能，以促进他们在披露过程中的参与（即，在披露式披露阶段）适合于一名儿童的方式。主要目的是：（1）评估专家的结构化，与文化相关的披露干预措施对专家提供的护理人员的影响，作为常规HIV医疗保健的一部分对照料者披露在1年期随访的儿科艾滋病毒披露的率与治疗，与惯例的基础知识和平衡的特征相比（2）的基础（2）的基础（E. e。儿科艾滋病毒的护理人员披露在1年随访时独立于结构化披露干预措施。次要目的是：（3）评估艾滋病毒儿科披露对儿童（病毒，免疫，免疫，心理社会和行为）的依从性和健康结果的影响以及照料者（心理社会）（心理社会）因暴露与非暴露的限制性披露和（4）的限制性披露而变化（4）已披露艾滋病毒状况的专家，照料者和儿童。提供者，照顾者和儿童参与者将从加纳的第三次艾滋病毒诊所入学，并在随机后每3个月进行一次纵向结局，再到披露后24个月。