Background: Overwhelmed, under-trained medical staff working in resource-limited settings need efficient resources for HIV disclosure counselling. The objective of this study was to describe providers’ experiences using tablet computers for disclosure-related counselling with HIV-infected children and their caregivers in western Kenya, with additional perspectives from adolescents. Methods: A qualitative study design was implemented at three HIV clinics in western Kenya (Bumala, Busia, and Port Victoria) within Academic Model Providing Access to Healthcare (AMPATH). Twenty-one healthcare providers involved with pediatric disclosure were recruited and enrolled in the study. Initial interviews focused on understanding current disclosure practices and barriers. Tablets containing disclosure-related resources were distributed. Resources included short narrative videos created in this context to highlight issues relevant to child HIV disclosure. Results: Providers reported tablets improved disclosure, child participation, and medication adherence. All reported that reviewing materials increased their knowledge and comfort with disclosure. The most frequently used materials were the narrative videos and an animated video explaining the importance of medication adherence. Time was a major barrier for using the tablet. Clinician self-education persisted at one-year follow-up. Adolescents expressed enjoyment from viewing the tablet resources and had a better understanding of the importance of medication adherence. Conclusions: Tablet computers containing resources for disclosure are an acceptable and potentially effective resource to help providers support families with disclosure. Further work is needed to appropriately train the clinical providers in using the resources in a developmentally appropriate manner, as well as to develop new resources on adolescent-specific and HIV-related topics.

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Introduction: Over 15 million children who were exposed to HIV perinatally but uninfected (HEU) are alive globally, and they are faced with multiple risk factors for poor neurodevelopment. While children who are HIV-infected (HIV+) appear to have worse neurodevelopmental scores compared to children unexposed and uninfected with HIV (HUU), the evidence is mixed in children who are HEU. This small descriptive pilot study aimed to compare neurodevelopmental scores of children who are HIV+, HEU, and HUU in Kenya.Methods: This cross-sectional pilot study included children ages 18–36 months who were HIV+, HEU, or HUU. Neurodevelopment was assessed, along with sociodemographic, lab, and growth data. Statistical analysis included descriptive statistics, one-way ANOVA, chi-squared, and adjusted linear regression models.Results: One hundred seventy two were included (n = 24 HIV+; n = 74 HEU; n = 74 HUU). Mothers of children who were HEU experienced more depressive symptoms (p < 0.001). The only neurodevelopmental differences were found among groups was that children who were HIV+ had higher receptive language scores (p = 0.007). Lower height-for-age z-scores and being left home alone were associated with worse neurodevelopmental scores.Conclusions: Being stunted, left completely alone for at least an hour within the last week, and having higher sociodemographic status were associated with worse neurodevelopmental scores. The higher levels of depressive symptoms within mothers of children who are HEU warrants further investigation.

Objective. To understand the perspectives of clinical providers and caregivers regarding early childhood development (ECD) in children born to HIV-infected mothers in Kenya. Methods. This was a qualitative study of provider and caregiver perspectives on ECD at 5 Kenyan HIV clinics, using semistructured interviews and focus group discussions. Constant comparison and triangulation methods were employed to elucidate the concepts of ECD. Results. Twenty-five providers and 67 caregivers participated. While providers understood ECD in terms of milestones, caregivers strongly equated ECD with physical growth. Factors affecting ECD, such as nutrition, perinatal effects, and illness, were perceived differently by providers and caregivers. Both groups generally believed that HIV-infected children would have typical ECD if adherent to their HIV treatment. Conclusions. Important considerations regarding ECD in this population were uncovered. Understanding provider and caregiver perspectives’ on ECD in HIV-exposed children is critical for promoting ECD in this community.

The objective of this study was to determine and compare anemia and iron-deficiency anemia (IDA) rates in young Kenyan children who are HIV infected (HI), HIV exposed, uninfected (HEU), and HIV unexposed (HU). Questionnaires, anthropometrics, and blood samples were collected from HI, HEU, and HU aged 18 to 36 months. Descriptive statistics, Fisher’s exact tests, and linear regression were used for analysis. Of 137 total participants, HI (n = 18), HEU (n = 70), and HU (n = 49), 61.1%, 53.6%, and 36.7%, respectively, were anemic, with mean hemoglobin levels highest in HU ( P = .006). After adjusting for covariates, HI (β = −9.6, 95% CI:−17.3 to −2.0) and HEU (β = −7.4, 95% CI: −12.9 to −1.9) had lower hemoglobin levels compared with HU. The proportion of children with IDA did not differ significantly across groups ( P = .08). HEU have rates of anemia and IDA similar to HI. Anemia risk is generally higher in HEU than HU, even after adjusting for covariates.