Maternal HIV: Trial to Assist Disclosure to Children

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, 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. 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 pilot 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 include
secondary aims of:

1. increasing mothers' self-efficacy to disclose and respond to child questions
regarding HIV;

2. reducing mothers' fears regarding disclosure and stigma;

3. 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).