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：
8870398
负责人：
Lisa Michelle Butler
金额：
$ 20.65万
依托单位：
BOSTON CHILDREN'S HOSPITAL
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 2016-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8870398
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 Communication Country Direct Costs Disclosure Disease Education Educational Background Effectiveness Effectiveness of Interventions Emergency Situation Emotional Enrollment Event Expectancy Funding Guidelines HIV HIV diagnosis Health 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 cognitive development 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

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 Communication Country Direct Costs Disclosure Disease Education Educational Background Effectiveness Effectiveness of Interventions Emergency Situation Emotional Enrollment Event Expectancy Funding Guidelines HIV HIV diagnosis Health 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 cognitive development 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

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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.

描述（由申请人提供）：在2009年底，估计有210万儿童15岁以下患有艾滋病毒的儿童，近90％居住在撒哈拉以南非洲（SSA）。随着抗逆转录病毒疗法（ART）的可用性增加和改善的护理，越来越多的围产期感染儿童数量存活到青春期。乌干达估计有15万名HIV感染儿童。尽管针对儿童的艾滋病毒护理和治疗计划正在扩大，但卫生提供者和护理人员面临的挑战越来越大，是向受感染的儿童披露HIV血清。在SSA进行的研究表明，只有2％至37.8％的HIV感染儿童<15岁才知道其HIV状况。在乌干达，尽管艾滋病毒为儿童提供了迅速扩大，但很少有健康提供者接受了如何支持对感染儿童披露HIV诊断的正式培训。随着针对儿童的HIV护理和治疗计划，以满足SSA中越来越多的HIV感染儿童人群的需求，因此迫切需要有效，成本，具有成本性，适当的文化和可扩展性的披露干预措施，以提高照顾者与儿童有关慢性病和HIV的交流的能力，并促进持续的精神健康，行为和临床的临床范围，从而促进HIV的效果。我们提出了一个为期4年的项目，以测试我们旨在支持其护理人员向感染HIV感染的儿童发育中适当披露的认知行为干预的有效性。这种干预措施由社会认知理论和信息动机行为模型所告知，并将适应一个由艾滋病毒感染儿童的护理人员的多面计划的组成部分，由我们团队成员在美国总统艾滋病救济（PEPFAR）的紧急紧急计划的资金支持下开发。我们的具体目的是：目标1：确定认知行为干预的有效性，以增加护理人员对乌干达7-12岁的艾滋病毒感染者7-12岁儿童对儿童的艾滋病毒诊断的有效性。我们将使用在四个坎帕拉地区HIV诊所实施的阶梯楔形准经验评估干预措施，共有400个护理人员 - 孩子二元组，然后进行24个月。我们假设增强的干预措施将导致披露率提高。我们将比较参加干预措施的护理人员二元组和由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元组。目标2：确定披露对直接和长期护理人员和儿童心理健康以及儿童行为和临床结果的影响，以及干预是否会改变这些影响。我们假设干预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小儿艾滋病毒护理和治疗的国家政策提供信息。