A randomized clinical trial of an intervention to promote resilience in young children of HIV-positive mothers in South Africa

Abstract

Objective To assess the efficacy of an intervention designed to promote resilience in young children living with their HIV-positive mothers. Design/Methods HIV-positive women attending clinics in Tshwane, South Africa and their children, aged 6 - 10 years, were randomised to the intervention (I) or standard care (S). The intervention consisted of 24 weekly group sessions led by community care workers. Mothers and children were in separate groups for 14 sessions, followed by 10 interactive sessions. The primary focus was on parent-child communication and parenting. Assessments were completed by mothers and children at baseline and 6, 12 and 18 months. Repeated mixed linear analyses were used to assess change over time. Results Of 390 mother-child pairs, 84.6% (I:161 & S:169) completed at least two interviews and were included in the analyses. Children's mean age was 8.4 years and 42% of mothers had been ill in the prior three months. Attendance in groups was variable: only 45.7% attended >16 sessions. Intervention mothers reported significant improvements in children's externalizing behaviors (β=-2.8, P=0.002), communication (β=4.3, P=0.025) and daily living skills (β=5.9, P=0.024), while improvement in internalizing behaviors and socialization was not significant (P=0.061 and 0.052 respectively). Intervention children reported a temporary increase in anxiety but did not report differences in depression or emotional intelligence. Conclusions This is the first study demonstrating benefits of an intervention designed to promote resilience among young children of HIV-positive mothers. The intervention was specifically designed for an African context, and has the potential to benefit large numbers of children, if it can be widely implemented

Caregiving and Experiences of Health, Illness and Coping in the Context of Paediatric and Adolescent HIV and Poverty

“…Evidently, also in the study was a signiicant reduction in depression among children. Importantly, beneits were not only noticeable for the children but also for the HIV-positive caregivers who engaged in less-frequent avoidant coping behaviour [17]. A similar inding was found in Murphey and Marelich, who established that HIV-positive mothers in their study were able to beter cope, and this translated into beter adaptive potential in their children [39].…”

“…It is well demonstrated that resilience has the capacity to afect the long-term trajectory of a child's emotional, cognitive and adaptive functioning. In another large study conducted in Tswane, South Africa, among 390 mother-child pairs, an intervention that focused on mother-child dyads was not only able to enhance the parent-child relationship, but it also resulted in signiicant reduction in children's externalising behaviours, while improving the children's adaptive functioning [17], for at least a year following the intervention. Evidently, also in the study was a signiicant reduction in depression among children.…”

“…While evidence suggests that maternal illness is considered a risk for poor outcome in their children, where HIV-positive mothers were given the opportunity to enhance their capacity to deal with their illness and to strengthen parent-child relationship, the outcomes proved to beneit both the mental health of the caregiver and the child [33,39]. A few studies that emerged have started looking at the resilience in young children whose mothers are living with HIV in an atempt to improve developmental and psychosocial outcomes for both the HIV-infected mother and the child [17,33,39,47,58]. In the study with HIV-positive mothers from South Africa, there were also HIV-positive mothers who were able to express their own desires to live positively, for themselves and their children; they were also able to recognise how their own behaviour was afecting their children, and this had a positive impact on their ability to parent and communicate efectively with their children [58].…”

The power of siblings and caregivers: under-explored types of social support among children affected by HIV and AIDS

“…However, recent studies indicate children who are not yet orphaned, but living with an AIDS ill caregiver may also experience higher levels of psychological distress (Eloff et al, 2014). Many of these children have not yet been told of their caregiver’s HIV status, and disclosure within families remains a struggle, despite the health and psychological benefits associated with the process (Cheney, 2015).…”

Telling stories and adding scores: Measuring resilience in young children affected by maternal HIV and AIDS

“…The study was conducted within the context of a large randomised control study that spanned five years (Eloff et al, 2014). Within the large research, the need arose to garner additional data that would reflect the richness of the measurement of resilience in young children to a greater extent.…”