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. 2013 Feb 18;13:147. doi: 10.1186/1471-2458-13-147

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