Promoting Positive Caregiver-Child Interaction Between HIV-Affected Children and Their Caregivers with Depression in Kwa-Zulu Natal, South Africa
Depression is a serious public health concern, due to its negative impact of women's health, their infants and their families. HIV-infected caregivers are at high risk for a range of psychiatric and emotional problems that impact medication adherence and disease progression, and negatively affect mother-infant interactions, infant and child health, and development outcomes. Prior work emphasizes the need to supplement treatment of depression with interventions that promote parent responsiveness, encouragement of play and learning, positive discipline, and problem solving with regard to child rearing. However, there have been no studies of such interventions in low and middle income countries for HIV-infected caregivers with depression. We are developing a multi-faceted, home-based, community health worker (CHW)-delivered intervention that targets HIV-infected caregivers with diagnosed depression and their infants in rural and peri-urban communities in SA. We are planning an NIH R-01 research proposal to test the effectiveness and cost effectiveness of this intervention, which includes components to address linkage and retention of caregiver-child dyads in HIV care, caregiver mental health (e.g., depression and anxiety), caregiver child interaction, child growth and development. The present RAP project will serve to inform our planned intervention, providing essential background study of CHW's and depressed caregivers; knowledge, and documenting effective interactions that occur within household visits. Using qualitative methods (focus group discussions, observations of CHW household visits, interviews, and participatory design processes), we will study the most effective forms of engagement, including content, timing, and forms of interaction. We will select from existing stock a set of digital media - videos and narrated animations - and will design interaction prompts for a mobile technology support environment that will guide CHW adherence to our intervention protocol, and support productive discussions and exchanges between CHW and depressed, HIV infected caregivers.