Volume 58, Issue 8 p. 922-930
Original Article

Family-based promotion of mental health in children affected by HIV: a pilot randomized controlled trial

Theresa S. Betancourt

Corresponding Author

Theresa S. Betancourt

Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA

Correspondence

Theresa S. Betancourt, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, 12th Floor, Boston, 02115, MA, USA; Email: [email protected]

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Lauren C. Ng

Lauren C. Ng

Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA

Boston Medical Center, Boston, MA, USA

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Catherine M. Kirk

Catherine M. Kirk

Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA

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Robert T. Brennan

Robert T. Brennan

Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA

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William R. Beardslee

William R. Beardslee

Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA

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Sara Stulac

Sara Stulac

Brigham and Women's Hospital, Boston, MA, USA

Partners in Health, Boston, MA, USA

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Christine Mushashi

Christine Mushashi

Partners In Health/Inshuti MuBuzima, Rwinkwavu, Rwanda

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Estella Nduwimana

Estella Nduwimana

Partners In Health/Inshuti MuBuzima, Rwinkwavu, Rwanda

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Sylvere Mukunzi

Sylvere Mukunzi

Partners In Health/Inshuti MuBuzima, Rwinkwavu, Rwanda

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Beatha Nyirandagijimana

Beatha Nyirandagijimana

Partners In Health/Inshuti MuBuzima, Rwinkwavu, Rwanda

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Godfrey Kalisa

Godfrey Kalisa

Partners In Health/Inshuti MuBuzima, Rwinkwavu, Rwanda

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Cyamatare F. Rwabukwisi

Cyamatare F. Rwabukwisi

Partners In Health/Inshuti MuBuzima, Rwinkwavu, Rwanda

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Vincent Sezibera

Vincent Sezibera

College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda

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First published: 15 May 2017
Citations: 39
Conflicts of interest statement: No conflicts declared.

Abstract

Background

Children affected by HIV are at risk for poor mental health. We conducted a pilot randomized controlled trial (RCT) of the Family Strengthening Intervention (FSI-HIV), a family home-visiting intervention to promote mental health and improve parent–child relationships in families with caregivers living with HIV, hypothesizing that child and family outcomes would be superior to usual care social work services.

Methods

Eighty two families (N = 170 children, 48.24% female; N = 123 caregivers, 68.29% female) with at least one HIV-positive caregiver (n = 103, 83.74%) and school-aged child (ages 7–17) (HIV+ n = 21, 12.35%) were randomized to receive FSI-HIV or treatment-as-usual (TAU). Local research assistants blind to treatment conducted assessments of child mental health, parenting practices, and family functioning at baseline, post-intervention, and 3-month follow-up. Multilevel modeling assessed effects of FSI-HIV on outcomes across three time points. Trial Registration: NCT01509573, ‘Pilot Feasibility Trial of the Family Strengthening Intervention in Rwanda (FSI-HIV-R).' https://clinicaltrials.gov/ct2/show/;NCT01509573?term=Pilot+Feasibility+Trial+of+the+Family+Strengthening+Intervention+in+Rwanda+%28FSI-HIV-R%29&rank=1.

Results

At 3-month follow-up, children in FSI-HIV showed fewer symptoms of depression compared to TAU by both self-report (β = −.246; p = .009) and parent report (β = −.174; p = .035) but there were no significant differences by group on conduct problems, functional impairment, family connectedness, or parenting.

Conclusions

Family-based prevention has promise for reducing depression symptoms in children affected by HIV. Future trials should examine the effects of FSI-HIV over time in trials powered to examine treatment mediators.