Table 1.

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

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