Theory-based HIV Disclosure Intervention for Parents

因为预防艾滋病毒产前传播的计划正在惠及更多的孕妇 并成功地减少了垂直传播，越来越多的儿童出生于 艾滋病毒阳性的母亲没有感染。此外，新的医疗创新和越来越多的可用 抗逆转录病毒疗法(ART)改善了艾滋病毒阳性父母的健康和寿命，这意味着他们 更有可能在确诊后将孩子抚养很多年。针对艾滋病毒携带者的父母 (“公共卫生”)，向其血清阴性的子女披露他们感染艾滋病毒的情况(“父母披露艾滋病毒”)将成为一种 在父母、儿童和家庭的福祉方面，这一问题日益重要。中国的全球文学 父母艾滋病病毒的披露表明，适合发育的、有计划的披露信息可以极大地受益 人民解放运动及其子女和家庭的福祉。然而，出于多种原因，包括对耻辱的恐惧和 这样的知识可能会给他们的孩子带来心理负担，PLH经常纠结于是否、何时、 什么，以及如何与他们的孩子谈论他们感染艾滋病毒的问题。他们中的许多人没有透露自己感染艾滋病毒的情况 对孩子来说，主要是因为他们缺乏信心和行为技能来适当和有效地 完成这项任务。到目前为止，围绕父母艾滋病毒披露的问题还没有得到充分的研究， 特别是在低收入和中等收入国家，包括艾滋病毒流行的中国 稳步扩张。在本应用程序中，我们建议改编来自两个基于证据的 在美国开发的项目，旨在产生理论驱动的适合发育的父母艾滋病毒披露 在干预广西，中国，我们在那里建立了强大的研究基础设施和社区 自2004年以来，通过美国国立卫生研究院资助的研究开展合作。拟议的项目包括三个主要业务 阶段。第一阶段包括形成性研究，以检查当前的做法、障碍和促进者、文化 信息披露对PLH及其子女的影响和影响。将在此阶段收集的数据将 补充我们收集的数据，并将告知干预内容和交付的适应情况 情态。第二阶段包括开发和试点测试以理论为指导的父母艾滋病毒披露 包含两个组成部分(一级父母组成部分和二级护理提供者)的干预方案 通过在文化上适应和整合两个美国项目的方面，这两个项目在 要么帮助父母适当地披露艾滋病毒，要么改善PLH及其父母的心理健康状况 孩子们。第三阶段将严格评估拟议干预措施对公共卫生部门福祉的效果， 超过36个月的儿童和家庭通过一项涉及800名PLH(或 (父亲或母亲)及其子女(6至15岁)。这项研究还将确定上下文和 可能中介或缓和拟议干预措施对父母、子女、 和家庭结果。拟议的研究将解决缺乏有针对性的干预措施来支持父母 通过检查基于理论的干预是否可以 在低资源环境下改善父母艾滋病毒披露情况。拟议的研究还将提供跨文化 支持父母披露在父母、子女和家庭福祉中的作用的证据。

Because programs preventing prenatal HIV transmission are reaching a greater number of pregnant women worldwide and are successfully reducing vertical transmission, an ever increasing majority of children born to HIV-positive mothers are uninfected. In addition, new medical innovations and increasing availability of antiretroviral therapy (ART) have improved the health and longevity of HIV-positive parents, which means they are more likely to raise their children for many years after the initial diagnosis. For parents living with HIV ("PLH"), disclosing their HIV infection to their seronegative children ("parental HIV disclosure") becomes an increasingly important issue in terms of well-being of parents, children and families. The global literature in parental HIV disclosure suggests that developmentally appropriate, well-planned disclosure can greatly benefit the well-being of PLH, their children and families. However, for multiple reasons including fear of stigma and the psychological burden such knowledge might place on their children, PLH often struggle about whether, when, what, and how to talk to their children about their HIV infection. Many of them do not disclose their HIV infection to children primarily because they lack the confidence and behavioral skills to appropriately and effectively accomplish this task. To date, the issues surrounding parental HIV disclosure have been understudied, particularly in low- and middle-income countries (LMICs) including China where the HIV epidemic has been steadily expanding. In this application, we propose to adapt relevant components from two evidence-based programs developed in the US to produce a theory-driven developmentally appropriate parental HIV disclosure intervention in Guangxi, China, where we have built a strong research infrastructure and community collaboration through NIH-funded research since 2004. The proposed project consists of three main operational phases. Phase I includes formative research to examine current practices, barriers and facilitators, cultural influences, and effects of disclosure on PLH and their children. The data to be collected in this phase will complement the data we have collected and will inform the adaption of intervention content and delivery modality. Phase II includes the development and pilot-testing of a theory-guided parental HIV disclosure intervention program with two components (a primary parent component and a secondary care provider component) by culturally adapting and integrating aspects of two US-based programs that were efficacious in either helping parents to make appropriate HIV disclosure or improving mental health status of PLH and their children. Phase III will rigorously evaluate the efficacy of the proposed intervention on well-being of PLH, children and families over 36 months through a cluster randomized controlled trial involving 800 PLH (either fathers or mothers) and their children (6 to 15 years of age). The research will also identify contextual and individual factors that potentially mediate or moderate the effect of the proposed intervention on parent, child, and family outcomes. The proposed research will address the dearth of targeted interventions supporting parental efforts in disclosing their HIV status to their children by examining whether a theory-based intervention can improve parental HIV disclosure in a low-resource setting. The proposed study will also provide cross-cultural evidence to support the role of parental disclosure in the well-being of parents, children, and families.