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Maternal and child psychological outcomes of HIV disclosure to young children in rural South Africa: the Amagugu intervention

Rochat, Tamsen J.a,b,c; Arteche, Adriane X.d; Stein, Alanc,e; Mitchell, Joaniea,b; Bland, Ruth M.a,e,f

doi: 10.1097/QAD.0000000000000668
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Objectives: Increasingly, HIV-infected parents are surviving to nurture their children. Parental HIV disclosure is beneficial, but disclosure rates to younger children remain low. Previously, we demonstrated that the ‘Amagugu’ intervention increased disclosure to young children; however, effects on psychological outcomes have not been examined in detail. This study investigates the impact of the intervention on the maternal and child psychological outcomes.

Method: This pre-post evaluation design enrolled 281 HIV-infected women and their HIV-uninfected children (6–10 years) at the Africa Centre for Health and Population Studies, in rural South Africa. The intervention included six home-based counselling sessions delivered by lay-counsellors. Psychological outcomes included maternal psychological functioning (General Health Questionnaire, GHQ12 using 0,1,2,3 scoring); parenting stress (Parenting Stress Index, PSI36); and child emotional and behavioural functioning (Child Behaviour Checklist, CBCL).

Results: The proportions of mothers with psychological distress reduced after intervention: GHQ threshold at least 12 (from 41.3 to 24.9%, P < 0.001) and GHQ threshold at least 20 (from 17.8 to 11.7%, P = 0.040). Parenting stress scores also reduced (Pre M = 79.8; Post M = 76.2, P < 0.001): two subscales, parental distress and parent–child relationship, showed significant improvement, while mothers’ perception of ‘child as difficult’ was not significantly improved. Reductions in scores were not moderated by disclosure level (full/partial). There was a significant reduction in child emotional and behavioural problems (CBCL Pre M = 56.1; Post M = 48.9, P < 0.001).

Conclusion: Amagugu led to improvements in mothers’ and children's mental health and parenting stress, irrespective of disclosure level, suggesting general nonspecific positive effects on family relationships. Findings require validation in a randomized control trial.

aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Durban

bDepartment of Psychology, Stellenbosch University, Stellenbosch, South Africa

cSection of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK

dDepartment of Psychology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil

eSchool of Public Health, University of Witwatersrand, Johannesburg, South Africa

fInstitute of Health and Wellbeing, and Royal Hospital for Sick Children, University of Glasgow, UK.

Correspondence to Michael Richards E-mail:

Received 12 March, 2015

Revised 13 March, 2015

Accepted 13 March, 2015

Copyright © 2015 Wolters Kluwer Health, Inc.