Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe

Abstract

IntroductionHIV-exposed children show signs of developmental delay. We assessed the impact of a pragmatic multicomponent intervention for caregivers of HIV-exposed children aged 0–2 years in Zimbabwe.MethodsWe conducted a cluster-randomised trial from 2016 to 2018. Clusters were catchments surrounding clinics, allocated (1:1) to either National HIV guidelines standard of care or standard care plus an 18-session group intervention comprising i) early childhood stimulation (ECS) and parenting training with home visits to reinforce skills and retention in HIV care; ii) economic strengthening. Primary outcomes measured 12 months after baseline (4.5 months postintervention completion) included: i) global child development measured using the Mullen early learning composite score; ii) retention in HIV care. Analysis used mixed effects regression to account for clustering and adjusted minimally for baseline prognostic factors and was by intention to treat.ResultsThirty clusters, 15 in each arm, were randomised. 574 dyads were recruited with 89.5% retained at follow-up. Ninety one of 281 (32.4%) were recorded as having received the complete intervention package, with 161/281 (57.3%) attending ≥14 ECS sessions. There was no evidence of an intervention effect on global child development (intervention mean 88.1 vs standard of care mean 87.6; adjusted mean difference=0.06; 95% CI −2.68 to 2.80; p=0.97) or infant retention in care (proportion of children who had missed their most recent HIV test: intervention 21.8% vs standard of care 16.9%, p=0.18). There was weak evidence that the proportion of caregivers with parental stress was reduced in the intervention arm (adjusted OR (aOR)=0.69; 95% CI 0.45 to 1.05; p=0.08) and stronger evidence that parental distress specifically was reduced (intervention arm 17.4% vs standard of care 29.1% scoring above the cut-off; aOR=0.56; 95% CI 0.35 to 0.89; p=0.01).ConclusionThis multicomponent intervention had no impact on child development outcomes within 4.5 months of completion, but had an impact on parental distress. Maternal mental health remains a high priority.Trial registration numberPACTR201701001387209.

Cognitive and Educational Interventions for Orphans and Vulnerable Children Affected by HIV/AIDS: A Meta‐Analysis

“…(Bayley, 1993), the Cogstate neuropsychological battery, and the draw‐a‐person test. Interventions within this category included a Captains Log CCRT therapy (Sandford, 2007); brain‐training exercises designed to improve cognitive skills; a MISC (Klein & Hundeide, 1996), teaching caregivers to focus, excite, expand, encourage, and regulate child behavior to improve motor, cognitive, and psychosocial development of preschool‐age children; a home stimulation program (Potterton et al, 2010) revolving around activities of daily living and developmentally appropriate play; parenting classes and economic strengthening (Mebrahtu et al, 2019); and paid community‐based interventions (Tomlinson et al, 2017).…”

“…The funnel plot method indicated some concern for publication bias (Figure 3), as the studies with fewer subjects were scattered closer to the pooled effect size than the two studies with the largest samples. However, the two studies with the largest samples were also heterogeneous, with one including older children (Tomlinson et al, 2017) and the other including younger children (Mebrahtu et al, 2019). While the slight asymmetry in the funnel plot is not surprising given the multiple publications from the same authors (namely, Boivin and colleagues), these results should be interpreted with caution, as the funnel plot method may not be able to detect publication bias when the number of studies is small and heterogeneity is high (Lau, Ioannidis, Terrin, Schmid, & Okin, 2006).…”

“…Yet another intervention aimed at improving cognitive outcomes that took place in South Africa and consisted of a home stimulation program structured around activities of daily living based on concerns of the caregivers (Potterton, Stewart, Cooper, & Becker, 2010). Finally, one intervention delivered in Zimbabwe included parenting classes focusing on health, nutrition, and early childhood stimulation along with an economic strengthening intervention providing savings and lending, and regular visits by village health workers (Mebrahtu et al, 2019).…”

The impact of common mental disorders among caregivers living with HIV on child cognitive development in Zimbabwe

“…Data for this study were collected as part of a cluster-randomized controlled trial (The Child Health Initiative for Developmental Outcomes-CHIDO [PACTR201701001387209]). Details of the trial methods and outcome have been published previously (Chingono et al, 2018;Mebrahtu et al, 2019).…”

“…biological mothers and other caregivers) that completed mental health assessments at both time points as well as their children. Given that the intervention of the trial had no significant effect on child cognitive development (Mebrahtu et al, 2019) the data from all arms of the trial were pooled.…”