Family‐based HIV prevention and intervention services for youth living in poverty‐affected contexts: the CHAMP model of collaborative, evidence‐informed programme development

Bhana, Arvin; McKay, Mary M.; Mellins, Claude A.; Petersen, Inge; Bell, Carl C.

doi:10.1186/1758-2652-13-s2-s8

Cited by 62 publications

(51 citation statements)

References 52 publications

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“…Our results resonate with those of other family-focused interventions that have shown promise for HIV-prevention in South Africa [57] and for HIV-affected families in the United States [25,58,59] and Asia [60,61]. The FSI expands upon these important interventions by extending a focus to family-based mental health promotion for school-age children affected by HIV in rural sub-Saharan Africa using a family home visiting model.…”

Section: Discussionsupporting

confidence: 81%

Family-based prevention of mental health problems in children affected by HIV and AIDS

Betancourt

Kirk

et al. 2014

Aids

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Objective The objective of this study is to assess the feasibility and acceptability of an intervention to reduce mental health problems and bolster resilience among children living in households affected by caregiver HIV in Rwanda. Design Pre-post design, including 6-month follow-up. Methods The Family Strengthening Intervention (FSI) aims to reduce mental health problems among HIV-affected children through improved child–caregiver relationships, family communication and parenting skills, HIV psychoeducation and connections to resources. Twenty families (N=39 children) with at least one HIV-positive caregiver and one child 7–17 years old were enrolled in the FSI. Children and caregivers were administered locally adapted and validated measures of child mental health problems, as well as measures of protective processes and parenting. Assessments were administered at pre and postintervention, and 6-month follow-up. Multilevel models accounting for clustering by family tested changes in outcomes of interest. Qualitative interviews were completed to understand acceptability, feasibility and satisfaction with the FSI. Results Families reported high satisfaction with the FSI. Caregiver-reported improvements in family connectedness, good parenting, social support and children's pro-social behaviour (P<0.05) were sustained and strengthened from postintervention to 6-month follow-up. Additional improvements in caregiver-reported child perseverance/self-esteem, depression, anxiety and irritability were seen at follow-up (P<.05). Significant decreases in child-reported harsh punishment were observed at postintervention and follow-up, and decreases in caregiver reported harsh punishment were also recorded on follow-up (P<0.05). Conclusion The FSI is a feasible and acceptable intervention that shows promise for improving mental health symptoms and strengthening protective factors among children and families affected by HIV in low-resource settings.

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Section: Discussionsupporting

confidence: 81%

Family-based prevention of mental health problems in children affected by HIV and AIDS

Betancourt

Kirk

et al. 2014

Aids

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“…Results from the limited number of adherence studies conducted among children and adolescents in SSA have often found sub-optimal adherence to ART and poor virologic outcomes [14–18] and tend to focus on youth below the age of 15 [17,19–21]. In Zambia, research and donor reporting requirements have historically grouped ART patients aged ≥15 with adults and <15 with children, making it challenging to assess the numbers and clinical status of ALHIV [6].…”

Section: Introductionmentioning

confidence: 99%

“The sky is the limit”: adhering to antiretroviral therapy and HIV self‐management from the perspectives of adolescents living with HIV and their adult caregivers

Denison

Banda²,

Dennis

et al. 2015

Journal of the International AIDS Society

110

139

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IntroductionWorldwide, HIV-related mortality among adolescents living with HIV (ALHIV) increased by 50% from 2005 to 2012 and is attributed in part to a lack of support for adolescent retention to care and adherence to antiretroviral therapy (ART). This vulnerability reinforces the need to better understand incomplete ART adherence among ALHIV, particularly in sub-Saharan Africa, where the majority of the world's 2.1 million ALHIV reside.MethodsFrom December 2011 to February 2012, we conducted in-depth interviews with 32 ALHIV (aged 15 to 18) and 23 of their adult caregivers in the Copperbelt Province of Zambia. Interviews were transcribed and translated. An iterative qualitative process was used to code and analyze the data and main themes were summarized regarding the barriers to and facilitators of ART adherence.ResultsMore than a quarter of ALHIV reported missing a day or more of ART (ranging from one day to six months). Barriers to ART adherence included fear of disclosure and anticipated stigma. Few youth were willing to take their drugs outside of the home, which led to missed doses of ART. Similarly, families tended to manage HIV within the home only. As a result, although caregivers and families were often the greatest source of emotional and instrumental support, they coped with HIV in isolation of other potential support from their communities, schools or churches. Factors that supported ART adherence included attending clinic-sponsored youth groups, wanting to maintain one's health and using phone and clock alarms. Involvement of adult caregivers in HIV management varied greatly and was often based on the age and health status of the youth. Some caregivers struggled with letting the adolescents assume responsibility for their medication, and ALHIV had few self-management skills and tools to help them regularly take ART.ConclusionsThese data highlight the importance of families and home environments in supporting adherence to ART among ALHIV. Skill-building and family-based interventions to prepare ALHIV and their adult caregivers for HIV self-management and HIV status disclosure by youth are of paramount importance. Future research and programmes also need to address the fears adolescents and families have regarding HIV-related stigma that shape young peoples’ adherence behaviours.

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“…The youth in both groups had significantly higher sexual health knowledge scores when they reported having had conversations with their caregivers regarding sexual health, including sexual behavior, STDs, and birth control, even after adjusting for age, a finding consistent with prior studies of parent-child sexual communication (Aspy et al, 2007; Fisher, 1986; Fox & Inazu, 1980). Previous studies have called for family-based interventions that promote communication about sexual and reproductive health, and some studies have found that family-based services that support families affected by HIV, including both maternal and pediatric HIV, can improve parent-child relationships and promote communication about difficult topics such as sexuality, sexual risk, and familial HIV (Bhana, McKay, Mellins, Petersen, & Bell, 2010; Donenberg& Maryland, 2005; McKay et al, 2003; Rotheram-Borus, Murphy, Miller, & Draimin, 2008).…”

Section: Discussionmentioning

confidence: 99%

“…Although the pediatric HIV epidemic is virtually being eradicated in the U.S., this is not true internationally, particularly in low and middle income countries where there are 3.4 million children younger than 15 years estimated to be living with HIV (UNAIDS, 2013). Interventions such as CHAMP+, a family-based mental health and HIV Prevention program for perinatally HIV-infected early adolescents and their caregivers has now been successfully piloted in medical clinics in several countries including the U.S., South Africa, and Argentina (Bhana, McKay, Mellins, Petersen, & Bell, 2010; Bhana et al, 2013; McKay et al, in press) and may be a helpful tool in promoting family communication about safe sexual health behavior once the disclosure process has begun.…”

Section: Discussionmentioning

confidence: 99%

Sexual Health Knowledge in a Sample of Perinatally HIV-Infected and Perinatally Exposed Uninfected Youth

Gromadzka

Santamaria

Benavides

et al. 2015

Journal of HIV/AIDS & Social Services

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This study describes sexual health knowledge in perinatally HIV-infected (PHIV+) and perinatally-exposed uninfected (PHIV-) ethnic-minority youth, ages 9–16 years, residing in NYC (n=316). Data on youth sexual health knowledge (e.g., pregnancy, STDs, birth control) and caregiver-adolescent communication about sexual health were examined. Participants in both groups answered only 35% of the sexual health knowledge questions correctly (mean=6.6/19). Higher scores were found among youth who reported more communication about sex with caregivers (vs. those who did not report talking about sex with caregivers; 8.54 vs. 5.84, p<.001) and among PHIV+ youth who were aware of their status (vs. PHIV+ youth who were not; 7.27 vs. 4.70, p<.001). Age was positively correlated with sexual health knowledge (beta=.489, p<.001). Both PHIV+ and PHIV− youth had poor sexual health knowledge, suggesting a need for sexual health education for both groups. Data suggest that interventions focused on caregiver-child risk communication may be important for prevention.

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Family‐based HIV prevention and intervention services for youth living in poverty‐affected contexts: the CHAMP model of collaborative, evidence‐informed programme development

Cited by 62 publications

References 52 publications

Family-based prevention of mental health problems in children affected by HIV and AIDS

Family-based prevention of mental health problems in children affected by HIV and AIDS

“The sky is the limit”: adhering to antiretroviral therapy and HIV self‐management from the perspectives of adolescents living with HIV and their adult caregivers

Sexual Health Knowledge in a Sample of Perinatally HIV-Infected and Perinatally Exposed Uninfected Youth

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