Pilot Feasibility Trial of the Family Strengthening Intervention in Rwanda (FSI-R)

The research will examine the following Specific Aims:

Specific Aim 1: To adapt a U.S.-developed family-focused and strengths-based prevention program to the context of HIV/AIDS-affected families in Rwanda (the Family-Strengthening Intervention in Rwanda or "FSI-R") using prior qualitative findings and CAB input.

Specific Aim 2: To deliver the intervention to a small group of families to collect preliminary data on intervention feasibility, acceptability, and to further refine the intervention manual for the FSI-R.

Specific Aim 3: To conduct a pilot feasibility study of the FSI-R with 80 families.

In pursuit of Specific Aim 3, this research will (a) conduct a preliminary exploratory analysis to examine the extent to which the FSI-R for HIV/AIDS-affected families is associated with improved caregiver-child relationships using measures of family connectedness, good parenting, and social support. Hypothesis 1: Participants in the FSI-R will demonstrate increases in protective processes compared to usual care controls not exposed to the FSI-R. It will also (b) conduct a preliminary exploratory analysis to determine the extent to which improved caregiver-child relationships are sustained four months after the conclusion of the FSI-R. Hypothesis 2: Four months after the conclusion of the intervention, participants in the FSI-R will demonstrate increases in protective processes compared to usual care controls not exposed to the FSI-R.

The challenge of this project is to develop a family-based intervention to prevent mental health problems in children affected by HIV/AIDS that can be initiated as caregivers come into contact with health systems via routine HIV testing and care. Specifically, we propose to develop and pilot test a prevention-oriented family-strengthening intervention to mitigate the mental health risks facing HIV/AIDS-affected children (i.e., those who are HIV+ themselves or who have an HIV+ family member, including those who have died). The intervention design, which is based upon the Family-Based Preventive Intervention (FBPI), is centrally focused on galvanizing mechanisms of resilience in children and families and building on local sources of strength. Our unique adaptation and pilot study will employ a family focus to attend to the reality that HIV/AIDS is a family disease, and to show that individual, familial, and community resources may help families to succeed despite chronic illness. The pilot intervention will use a randomized design, drawing study participants (N=80 families) from social work referrals. Protective factors characterizing the family and mental health problems in children and caregivers will be assessed pre- and post-intervention. In addition, we will survey both participants and interventionists to provide qualitative and quantitative data on the program's cultural acceptability and feasibility, and on their own satisfaction.

Eligibility Criteria:
Inclusion criteria: All participants must be HIV/AIDS-affected (i.e., having an HIV+ family member, including those who have died). We will select single and dual caregiver families to reflect population dynamics in the area. Caregivers must be at least 18 years of age (the age of majority in Rwanda), must live in the same household as the children, and must be the child's legal guardian. Legal guardians may be aunts, uncles, grandparents, or foster parents. Caregivers must be willing to discuss HIV/AIDS with school-aged children in the family.

Exclusion Criteria: Potential participants will be excluded if they do not live in the Rwinkwavu catchment area. Untreated mental illness or active suicidal ideation/attempts in the family also constitutes exclusion criteria (mental health treatment for these problems may occur in conjunction with the FSI). HIV-positive children are ineligible for the study if their HIV status has not been disclosed to them. Exclusion criteria also include lack of caregiver willingness to discuss HIV/AIDS with school-aged children in the family. Youth-headed households will be excluded due to concerns about youth caregivers' capacity to participate in the FSI in addition to other caretaking duties.