Cognitive and Psychosocial Benefit of Caregiver Training for Ugandan HIV Children

描述(申请人提供)：研究主题：110,000名乌干达艾滋病毒儿童和100万名未受感染的艾滋病孤儿将因父母一方或双方患病或死于艾滋病而得不到或前后不一致的照料(联合国艾滋病规划署，2006年)。因此，这些儿童的认知和社会发展可能会在儿童早期发育迟缓，最终他们在学校的表现会更差。敏感照料者的调解干预(MISC)有一个结构化的课程和培训计划，每天向艾滋病毒母亲/照顾者传授增强其孩子在家里的认知和社交发展的技能。这是通过教母亲/照顾者如何集中孩子的注意力，激发孩子的兴趣，扩大她的认知意识，鼓励她的能力感，以及在游戏、喂养、洗澡和工作中规范行为来实现的。为了使MISC适应乌干达的情况，并证明其在促进艾滋病毒儿童和孤儿的认知和社会发展方面的有效性，我们将使用一个由四部分组成的方案来评估父母培训计划：背景评估、投入评估、过程评估和产品评估(CIPP评估模式)。研究目标1是通过利用当地社区领导人、教师和照顾者的焦点小组，与我们合作，使MISC适应乌干达的情况，对MISC进行背景评估。研究目标2包括通过访谈和培训遵从性对照顾者和家庭的MISC培训的适当性和可接受性的投入评估。研究目标3是通过家庭观察和家庭质量评估对干预的保真度进行过程评估，以及对母亲/照顾者和儿童之间的照看互动的录像带评估，以及在整个为期一年的培训期间照顾者自身态度和方法的变化。研究目的4评估MISC培训的结果或益处；根据儿童在早期学习的马伦量表、注意力的早期儿童警觉性测试(ECVT)、记忆的颜色-物体联想测试(COAT)和用于心理社会适应的儿童行为检查表(CBCL)上的收获。乌干达Kayunga区120名感染艾滋病毒的和120名未感染的学龄前艾滋病孤儿中，有一半的母亲/照顾者将被分配参加为期一年的每月家庭MISC培训。其余儿童和照顾者将继续接受每月定期的家庭保健访问。与非干预儿童相比，HIV感染和非感染孤儿的MISC将导致更大的马伦学习、ECVT注意力和外套记忆得分。这些收益将通过评估MISC功能、家庭规模的家庭环境质量以及基于家庭观察的儿童/照顾者质量互动(CCQI)分数的每月录像照看样本的改善分数来实现。这些成果将受到艾滋病毒儿童临床稳定性的影响。确定MISC照看培训的可行性和有效性，将为资源匮乏环境中数百万受艾滋病毒影响的儿童提供一种战略性和可持续的认知增强手段。除了儿科艾滋病毒感染对神经发育的直接影响外，全球数千万艾滋病毒孤儿的公共卫生负担是巨大的，因为考虑到它如何进一步损害家庭环境的质量和对已经贫穷的儿童的照顾。在非洲，以家庭为基础的照顾者培训干预措施，以改善受艾滋病毒影响儿童的发展环境，可能是缓冲他们免受艾滋病毒疾病影响的最具发展战略、文化相关性和资源可持续性的单一手段。更广泛地说，护理员培训干预措施还可以提高所有面临贫困和其他公共卫生挑战风险的儿童的认知能力和心理社会适应能力，以应对联合国千年发展目标的第二个目标，即确保所有儿童能够完成小学教育1。

DESCRIPTION (provided by applicant): Research Topic: 110,000 Ugandan HIV children and 1 million non-infected AIDS orphans will have poor or inconsistent caregiving because one or both parents are ill or dead from AIDS (UNAIDS 2006). Consequently, the cognitive and social development of these children may be stunted in early childhood, and eventually they will perform more poorly in school. Mediational intervention for sensitizing caregivers (MISC) has a structured curriculum and training program to teach HIV mothers/caregivers the skills for enhancing their child's cognitive and social development in the home each day. This is done by teaching mothers/caregivers how to focus a child's attention, excite a child's interest, expand her cognitive awareness, encourage her sense of competence, and regulate behavior during play, feeding, bathing and working. To adapt MISC to the Ugandan context and demonstrate its effectiveness for enhancing the cognitive and social development of HIV children and orphans, we will use a four-part protocol for evaluating parent training programs: context evaluation, input evaluation, process evaluation, and product evaluation (CIPP Model of Evaluation). Study Aim 1 is the context evaluation of MISC through the use of focus groups of local community leaders, teachers, and caregivers, partnering with us to adapt MISC to the Ugandan context. Study Aim 2 involves the input evaluation of appropriateness and acceptability of MISC training for the caregivers and household through interviews and training compliance. Study Aim 3 is the process evaluation of the fidelity of intervention though home observation and evaluation of HOME quality, and videotape evaluation of caregiving interactions between mother/caregiver and child, as well as changes in the caregivers own attitudes and approach throughout the year-long training period. Study Aim 4 evaluates the product or benefit of the MISC training; in terms of the child's gains on the Mullen Scales of Early Learning, the Early Childhood Vigilance Test (ECVT) of attention, the Color-Object Association Test (COAT) for memory, and the Child Behavior Checklist (CBCL) for psychosocial adjustment. Mothers/caregivers of half of 120 HIV-infected and 120 non-infected preschool AIDS orphans in Kayunga District, Uganda, will be assigned to monthly home-based MISC training for one year. The remaining children and caregivers will continue to receive the regular monthly home health care visits. MISC for both the HIV infected and non-infected orphans will lead to greater gains on the Mullen learning, ECVT attention, and COAT memory scores compared to non- intervention children. These gains will be mediated by improved scores on monthly videotaped caregiving samples evaluated for MISC features, HOME scale quality of home environment, and child/caregiver quality interactions (CCQI) scores from home-based observations. These gains will be moderated by clinical stability of the HIV children. Establishing the feasibility and effectiveness of MISC caregiving training will provide a strategic and sustainable means of cognitive enhancement for millions of HIV-affected children in resource-poor settings. Beyond the direct neurodevelopmental impact of pediatric HIV infection, the public health burden of HIV disease for tens of millions of HIV orphans globally is monumental when considering how it further compromises quality of home environment and caregiving for children already impoverished. In the African context, home-based caregiver training interventions to enhance the developmental milieu of HIV-affected children may be the single most developmentally strategic, culturally relevant, and resource sustainable means of buffering them from this impact of HIV disease. More broadly, caregiver training interventions may also enhance the cognitive ability and psychosocial adjustment of all children at risk from poverty and other public health challenges to the second of the UN Millennium Development Goals, which is to ensure that all children are able to complete primary schooling1.