Cognitive and Psychosocial Benefit of Caregiver Training for Ugandan HIV Children

乌干达艾滋病毒儿童护理人员培训的认知和社会心理益处

• 批准号: 7792212
• 负责人: Michael Joseph Boivin
• 金额: $ 19.52万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-03-21 至 2012-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7792212
• 关键词: 5 year old; Achievement; Acquired Immunodeficiency Syndrome; Affect; Africa; African; Age; Agriculture; Area; Attention; Attitude; Awareness; Bathing; Behavior; Biological; Boxing; Buffers; CD8B1 gene; Caregivers; Caring; Child; Child Behavior Checklist; Child Development; Child Language; Clinical; Cognitive; Color; Communities; Competence; Country; Developing Countries; Development; Disease; Economics; Educational Curriculum; Educational Intervention; Educational process of instructing; Effectiveness; Emotional; Ensure; Environmental Pollution; Evaluation; Extended Family; Family; Financial Support; Focus Groups; Fostering; Goals; Grief reaction; HIV; Health; Health Care Visit; Health Promotion; Home Care Services; Home environment; Home visitation; House Call; Household; Infant; Infection; Institutes; International; Intervention; Interview; Iron; Language; Lead; Learning; Left; Life; Link; Malaria; Malnutrition; Mediating; Mediator of activation protein; Medical; Memory; Modeling; Mothers; Motivation; Motor; Neurocognitive; Norway; Nursery Schools; Nutritional; Nutritional Support; Orphan; Outcome; Outcome Measure; Parents; Performance; Play; Population; Poverty; Process; Protocols documentation; Public Health; Research; Research Infrastructure; Research Methodology; Resources; Right-On; Risk; Risk Factors; Rural; Sahara; Sampling; Schools; Sensory; Series; Services; Social Development; Social Interaction; Social Work; Source; Stress; Structure; Testing; Training; Training Programs; Training Support; Trauma; UNICEF; Uganda; Videotape; Violence; Viral Load result; Walkers; Work; World Bank; adverse outcome; aged; base; caregiver education; caregiving; cognitive enhancement; deprivation; early childhood; experience; feeding; group intervention; immunological status; improved; interest; intergenerational; intervention program; iodine deficiency syndrome; maternal depression; member; neglect; nutrition; pediatric human immunodeficiency virus infection; professor; programs; psychosocial; psychosocial adjustment; rural area; skills; social; teacher; vigilance; virology

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.

描述（由申请人提供）： 研究主题：110,000 名乌干达艾滋病毒儿童和 100 万未感染艾滋病孤儿将因父母一方或双方因艾滋病患病或死亡而得不到良好或不一致的照顾（联合国艾滋病规划署，2006 年）。因此，这些孩子的认知和社交发展可能在幼儿期受到阻碍，最终他们在学校的表现会更差。敏感护理人员调解干预 (MISC) 拥有结构化课程和培训计划，旨在向艾滋病毒母亲/护理人员传授日常在家中增强孩子认知和社交发展的技能。这是通过教导母亲/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规范玩耍、喂养、洗澡和工作期间的行为来完成的。为了使 MISC 适应乌干达的情况并证明其在增强艾滋病毒儿童和孤儿的认知和社会发展方面的有效性，我们将使用由四部分组成的协议来评估家长培训计划：背景评估、输入评估、过程评估和产品评估（CIPP 评估模型）。研究目标 1 是通过由当地社区领袖、教师和护理人员组成的焦点小组对 MISC 进行背景评估，并与我们合作，使 MISC 适应乌干达的背景。研究目标 2 涉及通过访谈和培训合规性对护理人员和家庭的 MISC 培训的适当性和可接受性进行输入评估。研究目标 3 是通过家庭观察和家庭质量评估对干预保真度进行过程评估，对母亲/看护者与儿童之间的看护互动进行录像评估，以及看护者全年态度和方法的变化培训期。研究目标 4 评估 MISC 培训的产品或效益；儿童在马伦早期学习量表、注意力的早期儿童警戒测试（ECVT）、记忆的颜色-物体关联测试（COAT）以及社会心理调整的儿童行为检查表（CBCL）方面的进步。乌干达卡永加区 120 名艾滋病毒感染者和 120 名未感染的学前艾滋病孤儿中，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。其余的儿童和护理人员将继续接受每月定期的家庭保健就诊。与非干预儿童相比，HIV 感染者和未感染者孤儿的 MISC 将会在 Mullen 学习、ECVT 注意力和 COAT 记忆评分方面带来更大的收益。这些成果将通过每月录像看护样本得分的提高来调节，这些样本评估了 MISC 特征、家庭环境的家庭规模质量以及来自家庭观察的儿童/看护者质量互动 (CCQI) 得分。这些成果将受到艾滋病毒儿童临床稳定性的影响。确定 MISC 护理培训的可行性和有效性将为资源匮乏地区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方法。除了儿科艾滋病毒感染对神经发育的直接影响之外，考虑到艾滋病毒疾病如何进一步损害家庭环境质量和对已经贫困的儿童的照顾，艾滋病毒疾病给全球数千万艾滋病毒孤儿带来的公共卫生负担也是巨大的。在非洲背景下，旨在改善受艾滋病毒影响的儿童的发展环境的家庭护理人员培训干预措施可能是缓冲他们免受艾滋病毒疾病影响的最具发展战略性、文化相关性和资源可持续性的单一手段。更广泛地说，看护者培训干预措施还可以增强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社会心理适应能力，以实现联合国千年发展目标的第二个目标，即确保所有儿童都能完成小学教育1 。

项目成果

Nutritional and Immunological Correlates of Memory and Neurocognitive Development Among HIV-Infected Children Living in Kayunga, Uganda.

生活在乌干达卡永加的艾滋病毒感染儿童的记忆和神经认知发展的营养和免疫相关性。

• DOI: 10.1097/qai.0000000000000905
• 发表时间: 2016
• 期刊: Journal of acquired immune deficiency syndromes (1999)
• 作者: Ruiseñor-Escudero,Horacio;Familiar-Lopez,Itziar;Sikorskii,Alla;Jambulingam,Nikita;Nakasujja,Noelline;Opoka,Robert;Bass,Judith;Boivin,Michael
• 通讯作者: Boivin,Michael

CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care.

• DOI: 10.1007/s11904-016-0342-8
• 发表时间: 2016-12
• 期刊: CURRENT HIV/AIDS REPORTS
• 影响因子: 4.6
• 作者: Boivin, Michael J.;Ruiseor-Escudero, Horacio;Familiar-Lopez, Itziar
• 通讯作者: Familiar-Lopez, Itziar

Attention Test Improvements from a Cluster Randomized Controlled Trial of Caregiver Training for HIV-Exposed/Uninfected Ugandan Preschool Children.

• DOI: 10.1016/j.jpeds.2021.03.064
• 发表时间: 2021-08
• 期刊: The Journal of pediatrics
• 作者: Ikekwere J;Ucheagwu V;Familiar-Lopez I;Sikorskii A;Awadu J;Ojuka JC;Givon D;Shohet C;Giordani B;Boivin MJ
• 通讯作者: Boivin MJ