title: Family-based prevention of mental health problems in children affected by HIV and AIDS: an open trial.
abstract: OBJECTIVE
  The objective of this study is to assess the feasibility and acceptability of an intervention to reduce mental health problems and bolster resilience among children living in households affected by caregiver HIV in Rwanda.
  
  
  METHODS
  Pre-post design, including 6-month follow-up.
  
  
  METHODS
  The Family Strengthening Intervention (FSI) aims to reduce mental health problems among HIV-affected children through improved child-caregiver relationships, family communication and parenting skills, HIV psychoeducation and connections to resources. Twenty families (N = 39 children) with at least one HIV-positive caregiver and one child 7-17 years old were enrolled in the FSI. Children and caregivers were administered locally adapted and validated measures of child mental health problems, as well as measures of protective processes and parenting. Assessments were administered at pre and postintervention, and 6-month follow-up. Multilevel models accounting for clustering by family tested changes in outcomes of interest. Qualitative interviews were completed to understand acceptability, feasibility and satisfaction with the FSI.
  
  
  RESULTS
  Families reported high satisfaction with the FSI. Caregiver-reported improvements in family connectedness, good parenting, social support and children's pro-social behaviour (P < 0.05) were sustained and strengthened from postintervention to 6-month follow-up. Additional improvements in caregiver-reported child perseverance/self-esteem, depression, anxiety and irritability were seen at follow-up (P < .05). Significant decreases in child-reported harsh punishment were observed at postintervention and follow-up, and decreases in caregiver reported harsh punishment were also recorded on follow-up (P < 0.05).
  
  
  CONCLUSIONS
  The FSI is a feasible and acceptable intervention that shows promise for improving mental health symptoms and strengthening protective factors among children and families affected by HIV in low-resource settings.
authors.affiliation: aDepartment of Global Health and Population, Harvard School of Public Health bFrançois-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA cPartners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda dDepartment of Psychiatry, Boston Children's Hospital ePartners In Health, Boston, Massachusetts, USA fDepartment of Clinical Psychology, University of Rwanda, Butare, Rwanda.
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Ng
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Kirk
authors.forename: Morris
authors.initials: M
authors.lastname: Munyanah
authors.forename: Christina
authors.initials: C
authors.lastname: Mushashi
authors.forename: Charles
authors.initials: C
authors.lastname: Ingabire
authors.forename: Sharon
authors.initials: S
authors.lastname: Teta
authors.forename: William R
authors.initials: WR
authors.lastname: Beardslee
authors.forename: Robert T
authors.initials: RT
authors.lastname: Brennan
authors.forename: Ista
authors.initials: I
authors.lastname: Zahn
authors.forename: Sara
authors.initials: S
authors.lastname: Stulac
authors.forename: Felix R
authors.initials: FR
authors.lastname: Cyamatare
authors.forename: Vincent
authors.initials: V
authors.lastname: Sezibera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D005192:Family Health; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000517:prevention & control* / Q000628:therapy*; D008603:Mental Health; D008875:Middle Aged; D010287:Parent-Child Relations; D055500:Resilience, Psychological; D012432:Rwanda