Service Providers' Program for Maternal HIV Disclosure to Children in Thailand

描述（由申请人提供）：随着抗逆转录病毒疗法（ART）在泰国的出现（Vijayaraghavan等人，2007; Ivers等人，2005年），感染艾滋病毒的母亲寿命更长。随着艾滋病毒感染者转变为对泰国家庭产生多重影响的慢性疾病（Pequegnat等人，2001，2002; DeMatteo等人，2002; Rotheram-Borus等人，2005年），艾滋病毒披露的积极益处变得更加突出（Apinundecha等人，2007年）。世界卫生组织（世卫组织）最近发布了一套建议，供服务提供者参考，说明如何通过向儿童披露艾滋病毒状况来支持母婴传播，并指出，母婴传播如果向儿童披露其艾滋病毒状况，确实对儿童和母婴传播有益（世卫组织，2011年）。这项拟议的研究建立在泰国东北部艾滋病毒披露的现有项目（1 K 01 MH 085503 [PI：Lee]）的基础上，主要有两个方面：1.干预目标：目前在泰国东北部进行的干预试点侧重于向成年家庭成员（例如，父母、伴侣、兄弟姐妹）。虽然从向成年家庭成员披露艾滋病毒状况所确定的挑战中吸取了经验教训，但在向儿童披露其状况时，包括儿童的年龄和认知发展，存在独特和独特的挑战（与向成年人披露不同）; 2.干预设计：目前的干预试点是由我们的研究小组直接向艾滋病毒感染者（PLH）提供的。拟议的研究将设计一个课程，而不是病人，但医院服务提供者，以更好地帮助病人围绕他们的披露决定。服务提供者面临的挑战是缺乏关于何时、如何以及在何种条件下应告知儿童其MLH艾滋病毒状况的指导方针。因此，他们可能会错过协助MLH解决这些问题的机会。为了满足这一需求，我们将为服务提供者制定一个课程，使他们能够成为MLH的支持者和激励者，并决定向儿童提供与年龄相适应的信息。建议的研究将分三个阶段进行。在第一阶段，形成性研究将通过深入访谈30名MLH（20名未向儿童披露，10名已向儿童披露其艾滋病毒状况）和10名服务提供者进行，以探索向儿童披露艾滋病毒的障碍和动机。在探讨披露艾滋病毒的障碍和动机时，将考虑到儿童的年龄和发展阶段，探讨适合儿童年龄的课程内容。基于第一阶段的研究结果，并使用披露过程模型（Disclosure Processes Model，简称EVM）的理论框架（Chaudoir，Fisher和Simoni，2011），我们将在第二阶段为服务提供者制定一个适合年龄的孕产妇艾滋病毒披露课程，通过一系列焦点小组，让20名MLH和10名服务提供者参与，以制定课程的内容、格式和交付方式。在第三阶段，我们将与40个服务提供者试点课程。3个月后，我们将通过与40个服务提供者和40个从服务提供者那里接受课程的MLH的焦点小组来评估该课程。

DESCRIPTION (provided by applicant): With the advent of antiretroviral therapy (ART) in Thailand (Vijayaraghavan et al., 2007; Ivers et al., 2005), Mothers Living with HIV (MLH) are living longer. As living with HIV transitions into a chronic illness with multiple effects on familes in Thailand (Pequegnat et al., 2001, 2002; DeMatteo et al, 2002; Rotheram-Borus et al., 2005), the positive benefits of HIV disclosure is becoming more salient (Apinundecha et al., 2007). The World Health Organization (WHO) recently released a set of recommendations for service providers on how to support MLH with disclosure of HIV status to their children, stating that there is, indeed, benefit to health for children and MLH if MLH disclose their status to children (WHO, 2011). This proposed study builds on the current project on HIV disclosure in northeastern Thailand (1K01MH085503 [PI: Lee]) in two ways: 1. Intervention target: The current intervention pilot in northeastern Thailand focuses on disclosure challenges to adult family members (e.g., parents, partners, siblings). Although there are lessons learned from the challenges identified from disclosing HIV status to adult family members, there are unique and distinct challenges (different form disclosing to adults) when it comes to disclosing their status o children, including the age and cognitive development of the child; and 2. Intervention design: The current intervention pilot is being given directly to People Living with HIV (PLH) by our research team. The proposed study will design a curriculum not for patients but the hospital service providers to better assist patients around their disclosure decisions. Service providers are challenged by the lack of guidelines on when, how, and under what conditions children should be informed about their MLH's HIV status. Thus, they may miss opportunities to assist MLH with these issues. To address this need, we will develop a curriculum for service providers to empower them to become a supporter and motivator for MLH with their decisions around age-appropriate disclosure to children. The proposed study will proceed in three phases. In Phase 1, formative study will be conducted via in-depth interviews with 30 MLH (20 who have not disclosed and 10 who have disclosed their HIV status to children) and 10 service providers to explore the barriers and motivators around HIV disclosure to children. In exploring the barriers and motivators to HIV disclosure, age-appropriate curriculum contents will be explored by taking into account children's age and developmental stage. Based on the findings from Phase 1 and using the Disclosure Processes Model (DPM) theoretical framework (Chaudoir, Fisher, & Simoni, 2011), we will develop an age-appropriate maternal HIV disclosure curriculum for service providers in Phase 2 by engaging 20 MLH and 10 service providers through a series of focus groups to develop the content, format, and delivery of the curriculum. In Phase 3, we will pilot the curriculum with 40 service providers. After 3 months, we will evaluate the curriculu through focus groups with 40 service providers and 40 MLH who received the curriculum from the service providers.