Lisa Armistead - US grants

[unreadable] DESCRIPTION (provided by applicant): South Africa has an HIV-infection rate of 4.7 million (approximately 1 in 9 people). Between 1995 and 2005 South Africa is expected to have the highest number of AIDS-related deaths on the African continent, a total of 2.7 million. Many infected individuals are mothers. However, there is very little research conducted with South African women examining the relationship between maternal HIV-infection and family processes. Research conducted in the United States indicates that maternal HIV-infection compromises parenting, and that the extent to which parenting is compromised depends, at least in part, on a mother's resources. In order to identify resources that may enhance an infected woman's parenting abilities, within the unique sociocultural context of South Africa, additional research is needed. In the proposed study, we will examine a group of HIV-infected Black South African mothers and a community control sample. Aim One of this study is to investigate the impact of maternal HIV-status on family structural resources. Four categories of resources will be assessed: 1) material (shelter, nutrition, healthcare, and economic); 2) social (stigma, non-family social support, and community agencies); 3) family (maternal power and status, family social support, support from co-parent, and allocation of resources); and 4) personal (maternal psychological functioning, parenting efficacy, and spirituality). Aim Two is to examine the relationship between maternal HIV-status and parenting, as moderated by the aforementioned structural resources (Figure 1). In particular, parenting variables will include parent-child relationship and parental supervision of the child. The study's purpose is to identify potential protective factors that could be directly addressed through community-based interventions. Interventions that enhance protective parenting, which has been associated with decreased child sexual risk-taking in the United States, may decrease the spread of HIV in South Africa. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): The stunning beauty of the South African landscape and the palpable sense of hope pervading South African society in the post-apartheid era contrast starkly to the burden of approximately 5.5 million people infected with AIDS (UNAIDS, 2006). HIV prevalence among South African youth is particularly alarming. Existing research illustrates the potential of families to shape adolescent behavior in general. Families may, therefore, hold one key to slowing the epidemic. Our long-range goal is to advance the state of family-based preventive interventions that stem the spread of HIV. Our objective is to develop an efficacious family-based preventive intervention for families before their children become sexually active. The central hypothesis that guides our work is that enhancing caregivers'capacity to care is related to reduced risk and vulnerability among children and young adolescents. Our first specific aim is to design a culturally sensitive family-based intervention modeled after the Parents Matter! Program and informed by existing general parenting interventions in Southern Africa and formative research with community stakeholders, leaders, and families. Our second specific aim is to implement the intervention with 80 families recruited through a local non-governmental organization. Our third specific aim is to evaluate the intervention's efficacy and effectiveness with process and outcome measures, tailored to the South African context. In our proposed work we plan to move beyond simple dissemination of an existing successful intervention to thoroughly adapting it to a vastly different culture, address concretely the existence of HIV and violence in parents'lives, including how these factors can compromise parenting, and how they can be overcome, and bring together a diverse team of researchers, practitioners, parents, children, and community leaders to develop, implement, and evaluate the intervention. We expect this initial study to lay the groundwork for a full-scale family-based intervention trial with an ultimate outcome of reducing HIV transmission among South African youth. PUBLIC HEALTH RELEVANCE: South Africa faces dire threats posed by the HIV/AIDS epidemic, which compromises public health and the well-being of over 5.5 million South Africans and their communities. This project will develop, implement, and evaluate a family-based intervention to stem the tide of the virus among South African youth.

DESCRIPTION (provided by applicant): The purpose of this Collaborative R01, under Program Announcement PAR-09-153, is to conduct a full-scale trial of an intervention to assist mothers living with HIV (MLH) with disclosing their serostatus to their young (age 6 - 14 year old), well children. A pilot study of the intervention has recently been completed (R01 MH077493) and met its major aims. The basis for development of the pilot intervention was work from three R01s (MH057207, currently Yr. 14) designed to longitudinally assess MLH and their children. Within that work, several studies were conducted on maternal disclosure (e.g., Murphy, Marelich, & Hoffman, 2002; Murphy, Roberts, & Hoffman, 2002; Murphy, Roberts, & Hoffman, 2003; Murphy, Roberts, & Hoffman, 2006; Murphy, Steers, & Dello Stritto, 2001), suggesting disclosure is difficult, and outcomes for MLH and children could be improved by intervention. The pilot study, known in the community as Teaching, Raising, And Communicating with Kids (TRACK), was based on integrative disclosure theory (Derlega et al., 2004). Results of the pilot trial indicate that those in the intervention group were six times more likely to disclose their HIV/AIDS status to their child than those in the control group (O.R. 6.33) by the 9-month follow-up 33% of intervention MLH disclosed, compared to only 7.3% of the control group. Perhaps more importantly, the intervention group's emotional functioning and their satisfaction improved significantly following the intervention, compared to the control group Similarly, child mental health indicators among children of intervention MLH were significantly better than control group children at follow-ups. In this study, TRACK II, we propose to conduct a full-scale trial of the intervention in two sites: (1) Los Angeles county (Site 1, where the pilo trial was conducted), which will include a high proportion of Latina families and a smaller proportion of African-American and White families; and (2) Atlanta, Georgia (Site 2, where the primary consultant on the pilot trial conducts research), which will include a high proportion of Southern African-American families, as well as White families. MLH and their children (N = 440 total; 110 mothers and 110 children per site, n = 220 per site) will be assessed at baseline and at 3, 9, and 15-month follow-ups. MLH will be randomly assigned to the intervention or control. Aims are to: 1. facilitate disclosure of the mothers' HIV status to the children, which will includ secondary aims of: a. increasing mothers' self-efficacy to disclose and respond to child questions regarding HIV; b. reducing mothers' fears regarding disclosure and stigma; c. improving maternal knowledge of child development and how to provide appropriate levels of information given the age of the child; 2. improve MLH mental health indicators over time (i.e., depression, anxiety, quality of life); 3. improve child mental health indicators over time (i.e., depression, anxiety, acting out behaviors); and 4. improve family functioning indicators (e.g., cohesion, perceived closeness between mother and child). PUBLIC HEALTH RELEVANCE: The purpose of this Collaborative R01 is to test the efficacy of a full-scale trial of a disclosure intervention for HIV-infected mothers with children age 6 - 14 years of age. The basis for development of this intervention is work from two previous R01s (MH057207, currently Yr. 14) designed to longitudinally assess HIV-positive mothers and their children. From that observational work, a disclosure intervention was developed and a pilot trial of the intervention was conducted. In the pilot study, mothers in the intervention group were more likely to disclose their serostatus to their children, and both mothers and children in the intervention group showed better mental health scores following disclosure than mothers and children assigned to the control condition. We are now in the third decade of the HIV epidemic, and few interventions, other than for prevention or medication adherence, are available for women living with HIV; the longitudinal design and increased sample size of this full scale trial o the intervention will allow us to explore maternal and child characteristics that may moderate or mediate the impact of disclosure (e.g., demographic factors such as age, gender, ethnicity; maternal HIV/AIDS stigma, and illness severity), as well as investigate in more detail the trajectories of children who have been disclosed to versus those who have not.

Project Summary/Abstract Child maltreatment is a global public health problem, affecting 70% of children in Kenya and significantly increasing children?s risk for negative sequelae (e.g., non-communicable diseases, injury, mental illness) across their lifespan. Parent training programs are key to addressing this global epidemic. In high-income countries, numerous evidence-based parenting programs address familial risk factors associated with maltreatment. The critical barrier to progress occurs in low- and middle-income countries, where few culturally specific programs are available. This project addresses this significant need by leveraging an existing parent training program and its implementation infrastructure. The objectives of this 2-year development study are to: (1) conduct the groundwork to bring SafeCare®, an evidence-based program, to the first location in Africa; and (2) continue and expand the collaborative partnership between Georgia State University (GSU) and Africa Mental Health Foundation (AMHF), our Nairobi partner, to promote the wellbeing of young children and families. Specifically, our project aims to: (1) establish a multi-disciplinary Stakeholder Task Force in Kenya to advise the research and adaptation processes, (2) assess the need and necessary adaptations for SafeCare in Kenya, (3) adapt and test the SafeCare curriculum and implementation, and (4) expand AMHF?s capacity in implementation science. AMHF successfully conducts quantitative research on mental health and substance use with school aged children (ages 6 to 17) and adults across Kenya. This project will expand AMHF?s research capacity for implementation science with respect to cultural adaption and scale-up of evidence-based prevention programs for young children (ages 0 to 5) and families across Kenya and Africa, through extensive partnerships amongst the SafeCare developers at GSU?s National SafeCare Training and Research Center and key country and regional stakeholders, including families, professionals, government, and researchers. We will use focus groups and in-depth interviews with parents, professionals working children and families, and other community stakeholders to understand the prevalent challenges facing parents and the country?s existing service infrastructure. Using the formative research data, we will adapt the SafeCare curriculum and implementation process for delivery with Kenyan families, paving the way for a more comprehensive project evaluating the effectiveness of the adapted curriculum. Our project?s long-term goals are to: (1) build sustainable research and implementation capacity in Kenya and Africa, and (2) design a parenting program to promote children?s wellbeing, and reduce child maltreatment, NCDs and injuries across the lifespan.