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Table 1 The Amagugu intervention detailing the six steps, purpose of the steps, materials and activities and session goals

From: Maternal HIV disclosure to HIV-uninfected children in rural South Africa: a pilot study of a family-based intervention

Session/Visit

Description

Purpose

Materials and activities

Session goals

1: Positive parenting

One-on-one counselling session between mother and lay counsellor which takes place by arrangement at the home

Assess mothers' readiness to disclose, offer psycho-education on disclosure steps, communicate pros and cons of disclosure, encourage an informed decision to participate and proceed with disclosure

My intervention steps poster

Increase mothers’ knowledge about age-appropriate disclosure

A3 illustrated colour poster

My intervention calendar

Increase mothers' understanding of risks and benefits of disclosure

A5 illustrated colour card

2: Positive families

Family visit co-facilitated by the counsellor and mother - family invited by the mother (either biological or socially-defined members); not an HIV specific activity as children are present

Engage family members in a fun family process, create a sense of belonging and pride, use a strengths-based model, communicate respect for culture and values, introduce concept of play-for-communication and materials

My family tree

Increase family awareness of parenting aims of the intervention

A2 family tree poster with 14 illustrated sticker characters

Encourage a sense of belonging among all family members

3: Positive life stories

One-on-one counselling session between mother and counsellor using artwork and narrative therapy activities

Improve emotional well-being of the mother in preparation for disclosure; use ‘head, hands and heart’ model to maintain empathy and introduce concepts of emotional work; use artwork to facilitate positive experiences of love, relationships and to unpack the story of becoming HIV infected and living with HIV; dispel myths and misperceptions about HIV and offer HIV information

My life story

Mother feels supported, respected and understood by the counsellor

A4 paper, artwork materials

Mother constructs a family/parenting narrative

My HIV story

Mother more emotionally contained and able to focus on the child

A4 illustrated HIV story telling exercise

Mother has confidence in her HIV specific knowledge

4: Positive practices

One-on-one training session to personalise 5-step disclosure intervention and practise using role-play

Offer specific guidance on planning and preparing the disclosure event (time, place and people)

Talk and play reminder

Mother increases her understanding of what is age-appropriate and is confident to talk about HIV in a child-friendly way

A5 illustrated colour card

Teach the 5- step process and what each step offers the child

Family life line

Mother develops and practises her own talking points, has a language to use in approaching disclosure

A4 card artwork and stickers

Demonstrate the 5-step disclosure intervention and teach age-appropriate activities and games

HIV body map

Reduce mothers' anxiety about ‘dreaded questions’ by developing child friendly and age-appropriate answers

A4 HIV body map game with stickers

Through practice ensure that mother is skilled, confident, and feels enabled to undertake disclosure using the intervention tools and materials.

Playing cards

Mother understands child’s needs for information, activity, reassurance and comfort

A7 10 matching pairs playing card set

Help mother develop her own child and family personalised materials

Safety hand

Mother is confident to proceed with disclosure

A4 card and pens for artwork

Allow for role playing, practice and development of personal talking points

Family treasures story book

A5 illustrated 14 page English-Zulu story book

5: Positive planning

One-on-one training session to train mother on health promotion activities and to prepare for a joint parent-child clinic visit

Encourage mothers to move beyond disclosure and increase health promotion and the child’s access to a health support network and improve custody planning. Demonstrate clinic visit games and activities and encourage mother to take the child on a clinic visit, empower mother to advocate for her own and her child’s health care needs, counsel around fears and stigma

Clinic visit reminder

Mothers move beyond disclosure to health promotion and planning

A5 illustrated colour card

Name tag

Mother is able to advocate for her and her children’s health rights

A8 name tag with beaded strap

Clinic check list

Mother ensures that HIV treatment is demystified and personalised for the child

A4 “I-spy” game

My care circle (health)

Health care environment becomes familiar

A4 illustrated card with health care contact information

Increase child’s participation

Child has increased understanding of healthy sexuality

6: Positive futures

Family session facilitated by mother and attended by counsellor, provides mother and children opportunities to share intervention learning and achievements

Reinforce play-for-communication, teach mothers basic skills for developmental play, provide positive reinforcement for emotional sharing, allows the child to participate, develop self efficacy and pride around intervention achievements

Uthando doll

Mothers have increased understanding about how children use play to communicate

Handmade ethnically appropriate doll

My care circle (custody)

Children feel valued and rewarded for participation

A4 illustrated card with emergency care contact information