Developmental status of preschool children receiving cART: a descriptive cohort study

Potterton, Joanne; Hilburn, Nicole; Strehlau, Renate

doi:10.1111/cch.12321

Cited by 19 publications

(25 citation statements)

References 22 publications

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“…The findings from this study support recommendations of the importance of providing long-term early childhood intervention programs for children with HIV living in challenging socioeconomic circumstances in South Africa [10, 14, 38, 39]. Preparing children for schooling through an early childhood play-based intervention will provide children with more opportunity to practice, learn, and develop through play [3, 23, 32].…”

Section: Discussionsupporting

confidence: 72%

A Feasibility RCT Evaluating a Play-Informed, Caregiver-Implemented, Home-Based Intervention to Improve the Play of Children Who Are HIV Positive

Ramugondo

Ferreira

Chung

et al. 2018

Occupational Therapy International

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Background/aim In South Africa, contextual factors have been identified as barriers to outdoor, unstructured play. The human immunodeficiency virus (HIV) and resulting progressive HIV encephalopathy (PHE) is a pandemic in this area, associated with development delays that are not addressed by highly active antiretroviral treatment (HAART). This study aimed to describe the playfulness in children with HIV and PHE on HAART living in challenging socioeconomic areas in South Africa aged 6 months to 8 years and to evaluate the feasibility and preliminary effectiveness of a play-informed, caregiver-implemented, home-based intervention (PICIHBI) for improving play. Methods A feasibility randomized control trial allowed for comparison of PICIHBI and conventional one-on-one occupational therapy interventions. Children were filmed playing pre-, mid-, and postintervention, using the Test of Playfulness (ToP) to assess playfulness. The PICIHBI comprised of 10 monthly sessions facilitated by an occupational therapist, involving group discussions with caregivers and periods of experiential play. Results Twenty-four children with HIV and/or PHE were randomized into one of the two intervention groups. Overall, the group (n = 24) had a median score of 0 (lowest item score) on nine of 24 ToP items and only had a median score of 3 (highest score) on two items. Pre- to postintervention overall ToP scores improved marginally for the PICIHBI group (n = 12) and the conventional group (n = 12). Between-group differences were not significant. The PICIHBI group demonstrated a significant increase in one ToP item score at midassessment. No significant ToP item changes were found in the conventional group. Conclusion Children with HIV were found to have the most difficulty on ToP items relating to the play elements of internal control and freedom from constraints of reality. The PICIHBI did not significantly improve children's play and was not more effective than the conventional intervention. Considerations for feasibility and effectiveness, including barriers to attendance, are discussed.

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Section: Discussionsupporting

confidence: 72%

A Feasibility RCT Evaluating a Play-Informed, Caregiver-Implemented, Home-Based Intervention to Improve the Play of Children Who Are HIV Positive

Ramugondo

Ferreira

Chung

et al. 2018

Occupational Therapy International

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“…While the GMDS is neither standardised nor validated in South Africa, it is the most widely used developmental assessment tool, is considered culturally fair and is used to assess young children including those exposed to HIV. 29,30,31,32,33,34,35,36 Vision was assessed clinically during testing and through the ability to track small cake decorations (‘hundreds and thousands’ test), which implies visual acuity of 6/24 or better. 37…”

Section: Research Methods and Designmentioning

confidence: 99%

Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life

Laughton¹,

Naidoo²,

Dobbels³

et al. 2019

South. Afr. j. HIV med.

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BackgroundAntiretroviral therapy (ART) started between 7 and 12 weeks of age improves neurodevelopmental outcomes in HIV-infected (HIV+) infants, but the impact of even earlier initiation is not yet described.ObjectivesWe assessed the early neurodevelopment of HIV+ infants who started ART within 21 days of life.MethodParticipants were enrolled from the public sector birth HIV-diagnosis programme. Inclusion criteria included the following: birth weight > 2000 g, infant commencing ART < 6 weeks and no infant cytomegalovirus disease. Antiretroviral therapy included Zidovudine/Lamivudine/Nevirapine for the first 2 weeks, the latter then replaced by Lopinavir/Ritonavir. Once body weight > 3 kg and gestational age > 44 weeks, Abacavir replaced Zidovudine. The Griffiths mental development scales (GMDS) were administered at 10–12 months.ResultsOf 29 infants assessed, 23 (79%) were girls. Mean birth weight was 3002 ± 501 g. Twenty-four mothers (83%) received ART during pregnancy. Seven (24%) infants were diagnosed HIV+ within 48 h of birth. Median [interquartile range] viral load (VL) at diagnosis was 3904 [259–16 922] copies/mL, age starting ART was 6.0 [3–10] days and age at VL suppression was 19.1 [15–36] weeks. At the GMDS assessment, nine (31%) participants had detectable VL and 26 (90%) had World Health Organization (WHO) clinical stage I disease. The GMDS was performed at a mean age of 11.5 ± 0.8 months. Mean quotients were within the average range: Global Griffiths score was 103.6 ± 10.9 and mean quotients on the subscales ranged from lowest 95.9 ± 13.4 for locomotor to highest 112.8 ± 11.3 for hearing-and-language.ConclusionPreliminary findings in this small group suggest that early neurodevelopmental scores are within the normal range in infants with perinatal HIV infection who started ART at a median of 6 days.

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“… 9 , 10 Neurological and cognitive impairments also influence the development of children living with HIV (CLHIV) bearing consequences for achievement at school. 2 , 11 , 12 , 13 These impairments can result in functional and participatory limitations, further compounded by the effects of contextual barriers resulting in disabilities. Although scholars and health professionals have recently adopted a biopsychosocial framework 14 to understand disability, less is understood about HIV-related disability.…”

Section: Introductionmentioning

confidence: 99%

Child functioning and disability in children living with human immunodeficiency virus in a semi-rural healthcare setting in South Africa

Maddocks

Mthethwa

Chetty

2020

African Journal of Primary Health Care & Family Medicine

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Background Children living with HIV (CLHIV) often experience HIV-related impairment and disability. Aim The study sought to understand the level of child functioning and access to rehabilitative care in the context of South African healthcare in order to inform an integrated rehabilitative framework. Setting District level semi-rural healthcare facility in KwaZulu-Natal. Methods The Washington Group/United Nations International Children’s Emergency Fund Module on Child Functioning, was administered to carers of CLHIV aged between 5 and 10 years, and accessing care at the study setting. Results Forty-four caregivers of children receiving treatment from June 2018 to March 2019, at the facility, participated. Four (9.1%) children had difficulty with seeing, 13 (29.5%) children had difficulty with hearing and 10 (22.7%) children had difficulty with walking. In the cognitive and behavioural domains, 17 (38.6%) children reported difficulties in communication and concentration, with 16 (36.4%) children experiencing difficulties in learning and remembering. Difficulties reported in accepting change and controlling behaviour were both experienced by 23 (52.3%) children. Although many children experiencing impairments were referred for rehabilitation, many caregivers did not follow-up after the initial assessment, because of financial constraints, lack of time and transport restrictions. Conclusion Functional difficulties were frequently experienced by children living with HIV. Disability screening would be beneficial at various points of care to promote early identification and timely referral to healthcare professionals. Decentralising rehabilitative care to homes and communities could offer a solution to some of the reported barriers to accessing care.

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Developmental status of preschool children receiving cART: a descriptive cohort study

Abstract: Despite having early access to cART, children infected with HIV are still at risk for severe developmental delay across a number of facets. Very early initiation of cART may help alleviate this problem. All preschool children infected with HIV should have routine developmental screening.

Cited by 19 publications

References 22 publications

A Feasibility RCT Evaluating a Play-Informed, Caregiver-Implemented, Home-Based Intervention to Improve the Play of Children Who Are HIV Positive

A Feasibility RCT Evaluating a Play-Informed, Caregiver-Implemented, Home-Based Intervention to Improve the Play of Children Who Are HIV Positive

Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life

Child functioning and disability in children living with human immunodeficiency virus in a semi-rural healthcare setting in South Africa

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