With the advent of antiretroviral therapy (ART) in Thailand (Vijayaraghavan et al., 2007;Ivers et al., 2005), Mothers Living with HIV (MLH) are living longer. As living with HIV transitions into a chronic illness with multiple effects on familes in Thailand (Pequegnat et al., 2001, 2002;DeMatteo et al, 2002;Rotheram-Borus et al., 2005), the positive benefits of HIV disclosure is becoming more salient (Apinundecha et al., 2007). The World Health Organization (WHO) recently released a set of recommendations for service providers on how to support MLH with disclosure of HIV status to their children, stating that there is, indeed, benefit to health for children and MLH if MLH disclose their status to children (WHO, 2011). This proposed study builds on the current project on HIV disclosure in northeastern Thailand (1K01MH085503 [PI: Lee]) in two ways: 1. Intervention target: The current intervention pilot in northeastern Thailand focuses on disclosure challenges to adult family members (e.g., parents, partners, siblings). Although there are lessons learned from the challenges identified from disclosing HIV status to adult family members, there are unique and distinct challenges (different form disclosing to adults) when it comes to disclosing their status o children, including the age and cognitive development of the child;and 2. Intervention design: The current intervention pilot is being given directly to People Living with HIV (PLH) by our research team. The proposed study will design a curriculum not for patients but the hospital service providers to better assist patients around their disclosure decisions. Service providers are challenged by the lack of guidelines on when, how, and under what conditions children should be informed about their MLH's HIV status. Thus, they may miss opportunities to assist MLH with these issues. To address this need, we will develop a curriculum for service providers to empower them to become a supporter and motivator for MLH with their decisions around age-appropriate disclosure to children. The proposed study will proceed in three phases. In Phase 1, formative study will be conducted via in-depth interviews with 30 MLH (20 who have not disclosed and 10 who have disclosed their HIV status to children) and 10 service providers to explore the barriers and motivators around HIV disclosure to children. In exploring the barriers and motivators to HIV disclosure, age-appropriate curriculum contents will be explored by taking into account children's age and developmental stage. Based on the findings from Phase 1 and using the Disclosure Processes Model (DPM) theoretical framework (Chaudoir, Fisher, &Simoni, 2011), we will develop an age-appropriate maternal HIV disclosure curriculum for service providers in Phase 2 by engaging 20 MLH and 10 service providers through a series of focus groups to develop the content, format, and delivery of the curriculum. In Phase 3, we will pilot the curriculum with 40 service providers. After 3 months, we will evaluate the curriculu through focus groups with 40 service providers and 40 MLH who received the curriculum from the service providers.
Service providers in Thailand can play a key role in assisting and supporting Mothers Living with HIV (MLH) in their HIV disclosure decisions. However, they first need clear guidelines to assist MLH on when, how, and under what conditions they should disclose their status to children. The proposed study aims to develop a skills-building curriculum for service providers in northeastern Thailand to assist and support MLH with their decisions around HIV disclosure to their children.