Comparative effectiveness of pediatric HIV disclosure interventions in Uganda

乌干达儿童艾滋病毒披露干预措施的比较效果

基本信息

批准号：
8390950
负责人：
Lisa Michelle Butler
金额：
$ 34万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-01 至 2013-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8390950
关键词：
12 year old 15 year old Acquired Immunodeficiency Syndrome Adolescence Adverse effects Africa Africa South of the Sahara Age Anxiety Area Attenuated Behavior Behavioral Caregivers Caring Characteristics Child Child Mental Health Child health care Chronic Disease Clinic Clinical Cognitive Cognitive Therapy Cognitive aging Communication Country Development Direct Costs Disclosure Disease Education Educational Background Effectiveness Effectiveness of Interventions Emergency Situation Emotional Enrollment Event Expectancy Funding Guidelines HIV HIV diagnosis Health Care Costs Health Personnel International Intervention Lead Learning Life Measures Mediating Medical Mental Depression Mental Health Modeling Motivation Outcome Policies Population Problem behavior Process Professional counselor Quasi-experiment Randomized Controlled Trials Recommendation Research Schedule Self Efficacy Services Techniques Testing Training Translating Uganda antiretroviral therapy burden of illness caregiver education child depression comparative effectiveness coping cost cost effective cost effectiveness design development policy disability weights disability-adjusted life years experience improved innovation intervention effect meetings member pediatric human immunodeficiency virus programs response scale up skills social cognitive theory standard care treatment program

项目摘要

DESCRIPTION (provided by applicant): At the end of 2009, there were an estimated 2.1 million children under the age of 15 years living with HIV, with almost 90% residing in sub-Saharan Africa (SSA). With increased availability of antiretroviral therapy (ART) and improved care, increasing numbers of perinatally infected children are surviving into adolescence. There are an estimated 150,000 HIV-infected children in Uganda. While HIV care and treatment programs for children are expanding, a growing challenge facing health providers and caregivers is disclosure of HIV serostatus to infected children. Studies conducted in SSA have indicated that only 2% to 37.8% of HIV-infected children < 15 years know their HIV status. In Uganda, despite the rapid expansion of HIV services for children, very few health providers receive formal training in how to support disclosure of an HIV diagnosis to an infected child. As HIV care and treatment programs for children are scaled up to meet the demand of a growing population of HIV-infected children in SSA, there is an urgent need for effective, cost-effective, culturally appropriate, and scalable disclosure interventions that improve caregivers ability to communicate with their child about chronic illness and HIV, and promote sustained positive mental health, behavioral and clinical outcomes of HIV-infected children who learn their HIV status. We propose a 4-year project to test the effectiveness of a cognitive-behavioral intervention that we have designed to support developmentally appropriate disclosure to HIV-infected children by their caregiver. The intervention is informed by social cognitive theory and the information-motivation-behavior model, and would adapt components of a multi- faceted program for caregivers of HIV-infected children, developed by members of our team with funding support from the US President's Emergency Plan for AIDS Relief (PEPFAR). Our specific aims are: AIM 1: To determine the effectiveness of a cognitive-behavior intervention for increasing disclosure of children's HIV diagnosis by caregivers to their HIV-infected children age 7-12 years old in Uganda. We will evaluate the intervention using a stepped wedge quasi-experiment implemented at four Kampala area HIV clinics, with a total of 400 caregiver-child dyads, and followed for 24 months. We hypothesize that the enhanced intervention will lead to increased disclosure rates. We will compare disclosure among caregiver- child dyads enrolled in the intervention and dyads enrolled in standard care guided by Uganda National guidelines for HIV Care and Treatment. AIM 2: To determine the effect of disclosure on immediate and longer- term caregiver and child mental health, and child behavioral and clinical outcomes, and whether the intervention modifies these effects. We hypothesize that the intervention will attenuate potential adverse effects of disclosure, including depression, anxiety, and behavioral problems. AIM 3: To assess the incremental cost, and cost-effectiveness of the intervention. The findings of this study will inform Ugandan and other countries national policies on pediatric HIV care and treatment. PUBLIC HEALTH RELEVANCE: With increased availability of antiretroviral therapy (ART) and improved care, increasing numbers of perinatally infected children are surviving into adolescence; a growing challenge facing health providers and caregivers is disclosure of HIV serostatus to infected children. This project will evaluate the effectiveness and costs of a cognitive-behavioral intervention to support developmentally appropriate disclosure to HIV-infected children in Uganda. The project has the potential to inform the development of policy and guidelines for pediatric HIV disclosure in clinical settings in Africa.

描述（由申请人提供）：截至 2009 年底，估计有 210 万 15 岁以下儿童感染艾滋病毒，其中近 90% 居住在撒哈拉以南非洲 (SSA)。随着抗逆转录病毒治疗 (ART) 的普及和护理的改善，越来越多的围产期感染儿童能够存活到青春期。乌干达估计有 150,000 名感染艾滋病毒的儿童。虽然针对儿童的艾滋病毒护理和治疗计划正在扩大，但卫生服务提供者和护理人员面临的一个日益严峻的挑战是向受感染的儿童披露艾滋病毒血清状况。 SSA 进行的研究表明，只有 2% 至 37.8% 的 15 岁以下 HIV 感染儿童知道自己的 HIV 状况。在乌干达，尽管针对儿童的艾滋病毒服务迅速扩大，但很少有卫生服务提供者接受过如何支持向受感染儿童披露艾滋病毒诊断结果的正式培训。随着针对儿童的艾滋病毒护理和治疗计划不断扩大，以满足撒哈拉以南非洲地区不断增长的艾滋病毒感染儿童的需求，迫切需要有效、具有成本效益、文化上适当和可扩展的披露干预措施，以提高护理人员的能力与孩子就慢性疾病和艾滋病毒进行沟通，并促进了解艾滋病毒感染状况的艾滋病毒感染儿童持续积极的心理健康、行为和临床结果。我们提出了一个为期 4 年的项目来测试认知行为干预措施的有效性，我们设计该干预措施的目的是支持照顾者向感染艾滋病毒的儿童提供适合其发展的信息。该干预措施以社会认知理论和信息动机行为模型为基础，并将采用针对艾滋病毒感染儿童护理人员的多方面计划的组成部分，该计划是由我们团队成员在美国总统紧急计划的资助下开发的艾滋病救援 (PEPFAR)。我们的具体目标是：目标 1：确定认知行为干预的有效性，以增加照顾者向乌干达 7-12 岁感染艾滋病毒的儿童披露儿童艾滋病毒诊断情况。我们将使用在坎帕拉地区四个 HIV 诊所实施的阶梯式楔形准实验（共有 400 名看护者与儿童对组）评估干预措施，并跟踪 24 个月。我们假设加强干预将导致披露率提高。我们将比较参与干预的照顾者-儿童二人组和接受乌干达国家艾滋病毒护理和治疗指南指导的标准护理的二人组的披露情况。目标 2：确定披露对即时和长期护理人员和儿童心理健康、儿童行为和临床结果的影响，以及干预措施是否会改变这些影响。我们假设干预措施将减轻披露的潜在不利影响，包括抑郁、焦虑和行为问题。目标 3：评估干预措施的增量成本和成本效益。这项研究的结果将为乌干达和其他国家关于儿科艾滋病毒护理和治疗的国家政策提供信息。公共卫生相关性：随着抗逆转录病毒治疗 (ART) 的普及和护理的改善，越来越多的围产期感染儿童能够存活到青春期；卫生服务提供者和护理人员面临的一个日益严峻的挑战是向感染儿童披露艾滋病毒血清状况。该项目将评估认知行为干预的有效性和成本，以支持向乌干达感染艾滋病毒的儿童提供适合发展的信息。该项目有可能为非洲临床环境中儿科艾滋病毒披露政策和指南的制定提供信息。