This 2-year pilot project, which will complement two currently funded investigations, is designed to test the effects of an 8-week group cognitive behavioral stress management (CBSM) intervention on affective distress, physical health and adherence in 50 school-aged children with HIV infection. We will evaluate the effects of CBSM on health status by measuring changes in HIV load and CD4+ cell counts. Research with children has demonstrated that cognitive-behavioral treatments (CBT) represent effective modalities for improving coping and diminishing affective distress. Research with HIV-infected adults has found that CBSM enhances or maintains adaptive coping strategies, decreases maladaptive coping, and improves immune status. We propose that a CBSM intervention tailored to children can enhance coping skills, and thus improve psychological and behavioral adjustment, thereby maximizing the opportunity to reconstitute compromised immune systems. While parental involvement may represent an important component of treatment for school-aged children, we plan to focus first on improving coping and self-management skills in children in order to enhance the feasibility of this small-scaled pilot investigation. This project closely integrates the psychological care of pediatric populations by recruiting participants, completing assessments and running the intervention sessions within the medical clinics of the university hospital. The study is a 2x4 randomized experimental design with experimental conditions (CBSM plus standard of care [SC]) versus a SC wait-list control (WLC) as the between-group factor and time point (baseline, pre-treatment, post treatment, 2-month follow-up) as the within-group factor. We hypothesize that the children who receive CBSM, when compared with the WLC group, will demonstrate lower levels of psychological distress, improved coping, better adherence, lower mean viral loads and decreased disease progression after receiving the psychosocial intervention. The long-term objective of the research is to evaluate whether children provided with coping skills and relaxation training will demonstrate improved psychological adjustment and better adherence, with concomitant improvement in immune status.
