Human and Social Development, Human Sciences Research Council, Durban, South Africa; Africa Centre for Population Health, University of KwaZulu-Natal, Somkhele, South Africa; MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK.
Africa Centre for Population Health, University of KwaZulu-Natal , Somkhele , South Africa.
Front Public Health. 2016 Aug 31;4:183. doi: 10.3389/fpubh.2016.00183. eCollection 2016.
Advances in access to HIV prevention and treatment have reduced vertical transmission of HIV, with most children born to HIV-infected parents being HIV-uninfected themselves. A major challenge that HIV-infected parents face is disclosure of their HIV status to their predominantly HIV-uninfected children. Their children enter middle childhood and early adolescence facing many challenges associated with parental illness and hospitalization, often exacerbated by stigma and a lack of access to health education and support. Increasingly, evidence suggests that primary school-aged children have the developmental capacity to grasp concepts of health and illness, including HIV, and that in the absence of parent-led communication and education about these issues, HIV-exposed children may be at increased risk of psychological and social problems. The Amagugu intervention is a six-session home-based intervention, delivered by lay counselors, which aims to increase parenting capacity to disclose their HIV status and offer health education to their primary school-aged children. The intervention includes information and activities on disclosure, health care engagement, and custody planning. An uncontrolled pre-post-evaluation study with 281 families showed that the intervention was feasible, acceptable, and effective in increasing maternal disclosure. The aim of this paper is to describe the conceptual model of the Amagugu intervention, as developed post-evaluation, showing the proposed pathways of risk that Amagugu aims to disrupt through its intervention targets, mechanisms, and activities; and to present a summary of results from the large-scale evaluation study of Amagugu to demonstrate the acceptability and feasibility of the intervention model. This relatively low-intensity home-based intervention led to: increased HIV disclosure to children, improvements in mental health for mother and child, and improved health care engagement and custody planning for the child. The intervention model demonstrates the potential for disclosure interventions to include pre-adolescent HIV education and prevention for primary school-aged children.
艾滋病预防和治疗手段的进步降低了艾滋病母婴垂直传播的风险，大多数感染艾滋病的父母所生的孩子本身并未感染艾滋病。感染艾滋病的父母所面临的一个主要挑战是向他们的孩子透露其艾滋病状况。他们的孩子进入了童年中期和青春期早期，面临着与父母疾病和住院相关的许多挑战，这些挑战常常因耻辱感和缺乏获得健康教育和支持而加剧。越来越多的证据表明，小学生有理解健康和疾病概念的发展能力，包括艾滋病，而且，如果没有父母主导的关于这些问题的沟通和教育，艾滋病暴露儿童可能面临更多的心理和社会问题的风险。Amagugu 干预措施是一种由非专业顾问提供的六节家庭为基础的干预措施，旨在提高父母向其小学生透露其艾滋病状况并提供健康教育的能力。该干预措施包括有关披露、医疗保健参与和监护权规划的信息和活动。一项针对 281 个家庭的无对照前后评估研究表明，该干预措施是可行的、可接受的，并能有效地增加母亲的披露。本文的目的是描述 Amagugu 干预措施的概念模型，该模型是在评估后开发的，展示了 Amagugu 旨在通过其干预目标、机制和活动来打破的风险途径；并概述 Amagugu 的大规模评估研究结果，以证明干预模型的可接受性和可行性。这种相对低强度的家庭为基础的干预措施导致：增加了向儿童披露艾滋病的情况，改善了母子的心理健康，以及提高了儿童的医疗保健参与度和监护权规划。该干预模型表明，披露干预措施有可能将青少年前艾滋病教育和预防纳入小学生。
