Early Childhood Development in Children Born to HIV-Infected Mothers: Perspectives From Kenyan Clinical Providers and Caregivers

McHenry, Megan S.; Oyungu, Eren; McAteer, Carole I.; Ombitsa, Ananda R.; Ayaya, Samuel; Vreeman, Rachel C.

doi:10.1177/2333794x18811795

Cited by 3 publications

(3 citation statements)

References 38 publications

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“…For children linked to multiple caregivers, the mother was preferentially selected, followed by the father. In western Kenya and other contexts in sub‐Saharan Africa, mothers are commonly the primary caregivers for children living with HIV . We elected to restrict our sample to those caregiver–child VLs that occurred within 90 days of one another, as we assumed this to be a reasonable period in which a temporal association between caregiver–child viral suppression could be evaluated.…”

Section: Methodsmentioning

confidence: 99%

Viral suppression among children and their caregivers living with HIV in western Kenya

et al. 2019

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Introduction Despite the central role of caregivers in managing HIV treatment for children living with HIV , viral suppression within caregiver–child dyads in which both members are living with HIV is not well described. Methods We conducted a retrospective analysis of children living with HIV <15 years of age and their caregivers living with HIV attending HIV clinics affiliated with the Academic Model Providing Access to Healthcare ( AMPATH ) in Kenya between 2015 and 2017. To be included in the analysis, children and caregivers must have had ≥1 viral load ( VL ) during the study period while receiving antiretroviral therapy ( ART ) for ≥6 months, and the date of the caregiver's VL must have occurred ±90 days from the date of the child's VL . The characteristics of children, caregivers and dyads were descriptively summarized. Multivariable logistic regression was used to estimate the odds of viral non‐suppression (≥ 1000 copies/ mL ) in children, adjusting for caregiver and child characteristics. Results Of 7667 children who received care at AMPATH during the study period, 1698 were linked to a caregiver living with HIV and included as caregiver–child dyads. For caregivers, 94% were mothers, median age at ART initiation 32.8 years, median CD 4 count at ART initiation 164 cells/mm 3 and 23% were not virally suppressed. For children, 52% were female, median age at ART initiation 4.2 years, median CD 4 values at ART initiation were 15% (age < 5 years) and 396 cells/mm 3 (age ≥ 5 years), and 38% were not virally suppressed. In the multivariable model, children were found more likely to not be virally suppressed if their caregivers were not suppressed compared to children with suppressed caregivers ( aOR = 2.40, 95% CI : 1.86 to 3.10). Other characteristics associated with child viral non‐suppression included caregiver ART regimen change prior to the VL , caregiver receipt of a non‐ NNRTI ‐based regimen at the time of the VL , younger child age at ART initiation and child tuberculosis treatment at the time of the VL . Conclusions Children were at higher risk of viral non‐suppression if their caregive...

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Section: Methodsmentioning

confidence: 99%

Viral suppression among children and their caregivers living with HIV in western Kenya

et al. 2019

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“…A third hypothesis is that certain aspects of development are more adaptive and highly prioritized in settings like Kenya compared to the U.S. but are not measured with assessments like the Bayley-3, thereby resulting in a lower score. As a general example of expectation differences between cultures, we previously found that Kenyan clinical providers were concerned when children were not walking independent by 12 months of age ( 50 ), whereas, the U.S. Centers for Disease Control expects that most children will not walk independently until 18 months ( 51 ). As with all assessments, the items are evaluated are on the constructs deemed important by the test developers, which may introduce scoring bias.…”

Section: Discussionmentioning

confidence: 99%

Neurodevelopmental Outcomes of Young Children Born to HIV-Infected Mothers: A Pilot Study

et al. 2021

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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.

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“…Prior studies, many involving the local community, informed the study design and consent process for this study. [42][43][44][45] At study completion, we will hold a series of meetings among healthcare providers caring for the recruited population (those who work within the MTRH antenatal and postnatal clinics and wards), as well as local village elders and chiefs. During these meetings, we will disseminate the results of the study.…”

Section: Patient and Public Involvementmentioning

confidence: 99%

Predicting neurodevelopmental risk in children born to mothers living with HIV in Kenya: protocol for a prospective cohort study (Tabiri Study)

et al. 2022

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IntroductionFor the growing number of children with in utero and postpartum exposure to HIV and/or antiretrovirals, it is unclear which exposures or risk factors play a significant role in predicting worse neurodevelopmental outcomes. This protocol describes a prospective longitudinal cohort study of infants born to mothers living with HIV and those born to mothers without HIV. We will determine which risk factors are most predictive of child neurodevelopment at 24 months. We aim to create a risk assessment tool to help predict which children are at risk for worse neurodevelopment outcomes.Methods and analysisThis study leverages an existing Kenyan cohort to prospectively enrol 500 children born to mothers living with HIV and 500 to those without HIV (n=1000 total) and follow them from birth to age 24 months. The following factors will be measured every 6 months: infectious morbidity and biological/sociodemographic/psychosocial risk factors. We will compare these factors between the two groups. We will then measure and compare neurodevelopment within children in both groups at 24 months of age using the Child Behaviour Checklist and the Bayley Scales of Infant and Toddler Development, third edition. Finally, we will use generalised linear mixed modelling to quantify associations with neurodevelopment and create a risk assessment tool for children ≤24 months.Ethics and disseminationThe study is approved by the Moi University’s Institutional Research and Ethics Committee (IREC/2021/55; Approval #0003892), Kenya’s National Commission for Science, Technology and Innovation (NACOSTI, Reference #700244) and Indiana University’s Institutional Review Board (IRB Protocol #110990). This study carries minimal risk to the children and their mothers, and all mothers will provide written consent for participation in the study. Results will be disseminated to maternal child health clinics within Uasin Gishu County, Kenya and via papers submitted to peer-reviewed journals and presentation at international conferences.

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Early Childhood Development in Children Born to HIV-Infected Mothers: Perspectives From Kenyan Clinical Providers and Caregivers

Cited by 3 publications

References 38 publications

Viral suppression among children and their caregivers living with HIV in western Kenya

Viral suppression among children and their caregivers living with HIV in western Kenya

Neurodevelopmental Outcomes of Young Children Born to HIV-Infected Mothers: A Pilot Study

Predicting neurodevelopmental risk in children born to mothers living with HIV in Kenya: protocol for a prospective cohort study (Tabiri Study)

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