Theory-based HIV Disclosure Intervention for Parents

因为预防产前艾滋病毒传播的项目正在惠及更多的孕妇， 世界各地，并成功地减少了垂直传播，越来越多的儿童出生， 艾滋病毒抗体呈阳性的母亲没有受到感染。此外，新的医疗创新和越来越多的可用性， 抗逆转录病毒疗法（ART）改善了艾滋病毒阳性父母的健康和长寿，这意味着他们 更有可能在最初诊断后抚养他们的孩子多年。艾滋病毒感染者的父母 艾滋病病毒感染者（“PLH”），向其血清反应阴性的子女披露其艾滋病毒感染情况（“父母艾滋病毒披露”）， 在父母、子女和家庭的福祉方面，这是一个日益重要的问题。全球文学在 父母的艾滋病毒披露表明，发展适当的，精心策划的披露可以大大受益 艾滋病毒携带者及其子女和家庭的福祉。然而，由于多种原因，包括害怕耻辱和 这些知识可能会给他们的孩子带来心理负担，PLH经常为是否，何时， 如何和他们的孩子谈论他们的艾滋病毒感染。他们中的许多人没有透露他们的艾滋病毒感染情况 主要是因为他们缺乏信心和行为技能， 完成这项任务。迄今为止，围绕父母艾滋病毒披露的问题尚未得到充分研究， 特别是在包括中国在内的低收入和中等收入国家， 稳步扩张。在本申请中，我们建议从两个基于证据的 在美国开发的项目，以产生理论驱动的发展适当的父母艾滋病毒披露 在中国广西，我们建立了强大的研究基础设施和社区， 自2004年以来，通过NIH资助的研究合作。该项目包括三个主要业务 阶段。第一阶段包括形成性研究，以审查当前的做法、障碍和促进因素， 的影响，和披露对PLH及其子女的影响。本阶段收集的数据将 补充我们收集的数据，并将为调整干预内容和提供信息 模态第二阶段包括理论指导的父母艾滋病毒披露的发展和试点测试 一个由两部分组成的干预计划（主要父母部分和二级护理提供者 通过文化适应和整合两个美国项目的各个方面， 无论是帮助父母进行适当的艾滋病毒披露，还是改善PLH及其子女的心理健康状况， 孩子第三阶段将严格评估拟议干预措施对艾滋病毒携带者福祉的有效性， 儿童和家庭超过36个月，通过一个集群随机对照试验，涉及800 PLH（或 父亲或母亲）及其子女（6至15岁）。该研究还将确定上下文和 可能介导或缓和拟议干预措施对父母，儿童， 家庭的结果。拟议的研究将解决缺乏有针对性的干预措施， 通过研究基于理论的干预是否可以 在低资源环境下改进父母艾滋病毒披露。这项研究还将提供跨文化的 有证据支持父母披露对父母、儿童和家庭福祉的作用。

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.