Maternal HIV: Intervention to Assist Disclosure to Children

描述(申请人提供)：这个为期3年的小型R01的目的是测试干预措施的初步效果，以帮助感染艾滋病毒的母亲向她们的年幼(6-12岁)健康的孩子披露她们的血清状况。此干预措施的开发基础是从两个R01(MH#5R01MH057207，目前是年。09)，旨在纵向评估艾滋病毒阳性母亲及其子女，其中包括关于母亲披露的研究(例如，Murphy，Marelich，&Hoffman，2002；Murphy，Marelich，Hoffman，&Schuster，2006；Murphy，Roberts，&Hoffman，2002；Murphy，Roberts，&Hoffman，2003；Murphy，Roberts，&Hoffman，2006；Murphy，Steers，&Dello Stritto，2001)。这项研究表明，艾滋病毒携带者(MLWHs)的母亲很难披露信息，拟议的干预措施可以改善母亲和儿童的结果。在前两个R01中收集的信息将用于制定简短的披露干预。MLWHs(N=80)将被随机分配到干预或控制条件。MLWHs和儿童(N=160)将在基线、3、6和9个月的随访中进行评估。干预母亲的随机分组(n=12)将被要求在她们最后一次随访后参加深入的定性访谈，以获得关于她们在研究中的经历的详细过程信息。干预的目的是：改善母子沟通和育儿技能--特别是与披露有关的技能。作为干预目标的结果，其他主要和次要结果包括：更愿意披露，以及披露本身；改善妇女健康和儿童心理健康指标；减少儿童行为问题，改善亲子关系和家庭功能。这项研究将提供重要的前瞻性、纵向数据，以了解MLWHs对披露其血清状况的适应情况，以及他们的子女对披露情况的适应情况。先前的研究表明，对于一些家庭来说，母亲和儿童的心理痛苦可能会在披露后立即增加，但会随着时间的推移而减少；本研究的纵向设计将使我们能够在整个披露过程中跟踪母亲和儿童。这项研究将对母婴特征进行评估，这些特征可能会缓和或调解披露的影响。最后，对每一次干预会议的程序评价以及对参加干预的部分MLWHs的深入定性访谈，将提供关于在全面试验披露干预之前需要解决的问题的信息。除了预防或坚持服药之外，对艾滋病毒携带者妇女几乎没有其他干预措施；这项研究将评估一种将帮助艾滋病毒阳性母亲处理严重家庭问题的干预措施。

DESCRIPTION (provided by applicant): The purpose of this small 3-year R01 is to test the preliminary efficacy of an intervention to assist HIV- infected mothers to disclose their serostatus to their young (age 6-12 year old), well children. The basis for development of this intervention is work from two R01s (MH # 5R01MH057207, currently Yr. 09) designed to longitudinally assess HIV-positive mothers and their children, which included studies on maternal disclosure (e.g., Murphy, Marelich, & Hoffman, 2002; Murphy, Marelich, Hoffman, & Schuster, 2006; Murphy, Roberts, & Hoffman, 2002; Murphy, Roberts, & Hoffman, 2003; Murphy, Roberts, & Hoffman, 2006; Murphy, Steers, & Dello Stritto, 2001). This research suggests disclosure is difficult for mothers living with HIV (MLWHs), and that outcomes for both mothers and children could be improved by the proposed intervention. Information gathered in the previous two R01s will be used to develop a brief disclosure intervention. MLWHs (N = 80) will be randomly assigned to the intervention or control condition. MLWHs and children (N = 160) will be assessed at baseline, 3, 6, and 9-month follow-ups. A random subset of intervention mothers (n = 12) will be asked to participate in an in-depth qualitative interview after their last follow-up, to obtain detailed process information on their experiences in the study. The aims of the intervention are to: improve mother-child communication and parenting skills-particularly as they relate to disclosure. As a result of the intervention aims, other primary and secondary outcomes include: increasing readiness to disclose, and disclosure itself; improving both MLWH and child mental health indicators; reducing child behavioral problems, and improving the parent-child relationship and family functioning. This study will provide important prospective, longitudinal data on MLWHs' adjustment to having disclosed their serostatus, and their children's adjustment to the disclosure. Previous research indicates that for some families, maternal and child psychological distress may increase immediately following disclosure, but will decrease over time; the longitudinal design of this study will allow us to follow mothers and children throughout the disclosure process. The study will allow evaluation of maternal and child characteristics that may moderate or mediate the impact of disclosure. Finally, process evaluations for each intervention session as well as in-depth qualitative interviews with a subset of MLWHs who attended the intervention will provide information on issues that need to be addressed prior to a full-scale trial of the disclosure intervention. Few interventions, other than for prevention or medication adherence, are available for women living with HIV; this study will evaluate an intervention that will help HIV-positive mothers deal with a serious family issue.