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Zhou Y, Tang K, Lu H, Chen H, Xie H, Li Z, Huang J, Fang N, Chen S, Wang H, He Q, Chen H, Liu X, Lan G, Zhu Q, Chen Y, Zhang X, Ruan Y, Liang S. Behavioral and emotional difficulties and HIV treatment outcomes among HIV-infected children in rural southwestern China. Child Adolesc Psychiatry Ment Health 2023; 17:51. [PMID: 37072804 PMCID: PMC10114443 DOI: 10.1186/s13034-023-00601-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/04/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Previous studies have not clearly demonstrated the impact of behavioral and emotional problems (BEDs) on treatment outcomes among HIV-infected children on antiretroviral therapy (ART). This study aimed to describe the prevalence of BEDs among this population and identify the factors associated with HIV treatment outcomes. METHODS This cross-sectional study was conducted in Guangxi, China, between July and August 2021. HIV-infected children answered questionnaires about BEDs, physical health, social support, and whether they have missed doses in the past month. BEDs were assessed using the Chinese version of the self-reported Strengths and Difficulties Questionnaire (SDQ-C). The self-reported survey data were linked to participants' HIV care information that was obtained from the national surveillance database. Univariate and multivariate logistic regression models were used to identify factors that were associated with missed doses in the past month and virological failure. RESULTS The study sample was 325 HIV-infected children. HIV-infected children had a higher proportion of abnormal scores on SDQ-C total difficulties compared to their peers in the general population (16.9 vs 10.0%; P = 0.002). An abnormal SDQ-C total difficulties score (AOR = 2.06, 95%CI: 1.10-3.88) and infrequency of receiving assistance and support from parents over the past 3 months (AOR = 1.85, 95%CI: 1.12-3.06) were significantly associated with missed doses in the past month. Between the ages of 14-17 years (AOR = 2.66, 95% CI: 1.37-5.16), female (AOR = 2.21, 95% CI: 1.20-4.08), and suboptimal adherence (AOR = 2.45, 95% CI: 1.32-4.57) were significantly associated with virological failure. CONCLUSIONS Children's mental health plays a role in HIV treatment outcomes. Psychological interventions should be promoted in pediatric HIV care clinics to improve children's mental health status and HIV treatment outcomes.
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Affiliation(s)
- Yesheng Zhou
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Kailing Tang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Hongyan Lu
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Hongli Chen
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Haomin Xie
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Zeyu Li
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Jinghua Huang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Ningye Fang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Siya Chen
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Hong Wang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Qin He
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Huanhuan Chen
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Xiu Liu
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Guanghua Lan
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Qiuying Zhu
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Yi Chen
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Xiangjun Zhang
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN, 38163, USA.
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
| | - Shujia Liang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China.
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Velo Higueras C, Martín-Bejarano García M, Domínguez-Rodríguez S, Ruiz Sáez B, Cuéllar-Flores I, García-Navarro C, Guillén Martín S, Ramos Amador JT, Navarro Gómez ML, González-Tomé MI. [Prevalence of psychological symptoms and associated risk factors in a Spanish sample of HIV-positive youth compared to uninfected peers]. An Pediatr (Barc) 2020; 96:S1695-4033(20)30489-6. [PMID: 33390357 DOI: 10.1016/j.anpedi.2020.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of the study was twofold: (i)to determine the prevalence of symptoms of depression and anxiety and sleep disturbances in young patients with vertically-transmitted HIV infection compared to uninfected peers, and (ii)to identify sociodemographic, psychosocial and medication-related variables and other clinical risk and protective factors related to psychological symptoms. METHODS We conducted a cross-sectional study in two groups with independent measures (36 youth with vertically transmitted HIV infection and 39 HIV-negative peers). We used three standardised assessment tools and a sociodemographic/psychosocial questionnaire (STAI, BDI, PSQI and adapted sociodemographic test). We performed univariate and multivariable analyses. RESULTS The univariate analysis did not find significant differences between groups either in psychosocial factors or in the clinical scores. The multivariable analysis found that the presence of psychological symptoms was strongly associated with sociodemographic factors and past events. CONCLUSIONS Psychosocial factors and the social environment seemed to correlate more strongly to psychological symptoms than HIV status and to explain better the current psychological state of individuals.
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Affiliation(s)
- Carlos Velo Higueras
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España; Fundación para la Investigación Biomédica i+12, Hospital Universitario 12 de Octubre, Madrid, España.
| | | | - Sara Domínguez-Rodríguez
- Fundación para la Investigación Biomédica i+12, Hospital Universitario 12 de Octubre, Madrid, España
| | - Beatriz Ruiz Sáez
- Biobanco VIH, Hospital Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; Laboratorio de Inmuno-Biología Molecular, Hospital Gregorio Marañón. Madrid, España
| | - Isabel Cuéllar-Flores
- Psicología Clínica, Servicio de Pediatría, Hospital Clínico San Carlos, Madrid, España
| | - Cristina García-Navarro
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España; Fundación para la Investigación Biomédica i+12, Hospital Universitario 12 de Octubre, Madrid, España
| | - Sara Guillén Martín
- Unidad de Enfermedades Infecciosas, Hospital de Getafe, Getafe, Madrid, España
| | - José Tomás Ramos Amador
- Instituto de Investigación Sanitaria Clínico San Carlos, Madrid, España; Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Clínico San Carlos, Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - María Luisa Navarro Gómez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Gregorio Marañón, Madrid, España; Red de Investigación Traslacional en Infectología Pediátrica, España
| | - María Isabel González-Tomé
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España
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Prevalence of psychological symptoms and associated risk factors in a Spanish sample of HIV-positive youth compared to uninfected peers. An Pediatr (Barc) 2020; 96:203-212. [DOI: 10.1016/j.anpede.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 05/12/2020] [Indexed: 11/18/2022] Open
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Abstract
Depression and human immunodeficiency virus disease are common co-occurring conditions among youth living with human immunodeficiency virus/AIDS. Depression serves as a risk factor for contracting the disease and for nonadherence to medications and adherence to safe sex practices. Although new infections are decreasing nationally, subpopulations of youths continue to have the highest rates of new infections, specifically ethnic and sexual minority youths. Depression contributes to poor health outcomes for youths with human immunodeficiency virus disease. Evidence-based psychotherapy and pharmacotherapy for depression are effective treatments. Integrated care with medical and mental health provides the best care for this population of youth.
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Affiliation(s)
- Tami D Benton
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3440 Market Street, Suite 400, Philadelphia, PA 19104, USA.
| | - Warren Yiu Kee Ng
- Division of Child and Adolescent Psychiatry, Columbia University Irving Medical Center, New York Presbyterian Hospital/Columbia University Medical Center, 635 W 165th St, #EI 610, New York, NY 10032, USA
| | - Denise Leung
- Child and Adolescent Pediatric Psychiatry Community Services, Division of Child and Adolescent Psychiatry, Columbia University Irving Medical Center, 3959 Broadway, MSCH 6N 615A, New York, NY 10032, USA
| | - Alexandra Canetti
- Special Needs Clinic and School Based Mental Health Program, Columbia University Irving Medical Center, 622 West 168th St, VC4 East, New York, NY 10032, USA
| | - Niranjan Karnik
- Department of Psychiatry & Behavioral Sciences, Rush Medical College, Rush University Medical Center, 1645 West Jackson Blvd., Suite 600, Chicago, IL 60612, USA
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Mpango RS, Rukundo GZ, Muyingo SK, Gadow KD, Patel V, Kinyanda E. Prevalence, correlates for early neurological disorders and association with functioning among children and adolescents with HIV/AIDS in Uganda. BMC Psychiatry 2019; 19:34. [PMID: 30665382 PMCID: PMC6341558 DOI: 10.1186/s12888-019-2023-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the prevalence of neurological disorders and their associated correlates and relations with clinical and behavioural problems among children and adolescents with HIV/AIDS (CA-HIV). METHODS This study involved a sample of 1070 CA-HIV/caregiver dyads who were evaluated at their 6-month follow-up visit as part of their participation in the longitudinal study, 'Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (the CHAKA study)'. Participants completed an extensive battery of measures that included a standardized DSM-5- referenced rating scale, the parent version (5-18 years) of the Child and Adolescent Symptom Inventory-5 (CASI-5). Using logistic regression, we estimated the prevalence of neurological disorders and characterised their associations with negative clinical and behavioural factors. RESULTS The overall prevalence of at least one neurological disorders was 18.5% (n = 198; 95% CI, 16.2-20.8). Enuresis / encopresis was the most common (10%), followed by motor/vocal tics (5.3%); probable epilepsy was the least prevalent (4%). Correlates associated with neurological disorders were in two domains: socio-demographic factors (age, ethnicity and staying in rural areas) and HIV-related factors (baseline viral load suppression). Enuresis/encopresis was associated with psychiatric comorbidity. Neurological disorders were associated with earlier onset of sexual intercourse (adjusted OR 4.06, 95% CI 1.26-13.1, P = 0.02). CONCLUSIONS Neurological disorders impact lives of many children and adolescents with HIV/AIDS. There is an urgent need to integrate the delivery of mental and neurological health services into routine clinical care for children and adolescents with HIV/AIDS in sub-Saharan Africa.
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Affiliation(s)
- Richard Stephen Mpango
- Department of Psychiatry, Mental Health Project, MRC/UVRI and LSHTM Uganda Research Unit, Makerere College of Health Sciences, P. O. Box 49, Entebbe, Uganda. .,Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mabarara, Uganda.
| | - Godfrey Zari Rukundo
- 0000 0001 0232 6272grid.33440.30Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mabarara, Uganda
| | - Sylvia Kiwuwa Muyingo
- Department of Psychiatry, Mental Health Project, MRC/UVRI and LSHTM Uganda Research Unit, Makerere College of Health Sciences, P. O. Box 49, Entebbe, Uganda ,Statistical Section, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kenneth D. Gadow
- 0000 0001 2216 9681grid.36425.36Department of Psychiatry, Health Sciences Centre, Stony Brook University, Stony Brook, New York, NY 11794-8790 USA
| | - Vikram Patel
- 000000041936754Xgrid.38142.3cDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Eugene Kinyanda
- Mental Health Project, MRC/UVRI and LSHTM Uganda Research Unit, P. O. Box 49, Entebbe, Uganda
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Interventions Addressing Neurodevelopmental Delay in Young Children Infected With and Exposed to HIV: A Scoping Review. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Das PK, Maiti S, Sinha NK. Abundance of psychiatric morbidity in perinatally HIV infected children and adolescents with comparison to their HIV negative sibling. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.npbr.2016.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Boivin MJ, Ruisenor-Escudero H, Familiar-Lopez I. CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care. Curr HIV/AIDS Rep 2016; 13:318-327. [PMID: 27783207 PMCID: PMC5107125 DOI: 10.1007/s11904-016-0342-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
There is growing concern that although the more severe forms of HIV-associated neurologic deficits are reduced following highly active anti-retroviral therapy (HAART), mild to moderate cognitive disorders may persist for years after HAART initiation and this may occur despite complete plasma viral suppression. According to the UNAIDS 2014 report, there were 3.2 million children living with HIV around the world at the end of 2013 and 91 % of these resided in sub-Saharan Africa. In the same year, only 24 % of children who needed antiretroviral treatment (ART) received it and 190,000 children died of AIDS-related illnesses. We propose that behavioral interventions are needed in combination with medical treatment and care in order to fully address the needs of children and adolescents in Africa living with HIV. In early childhood, caregiver training programs to enhance the developmental milieu of the child with HIV can enhance their cognitive and social development and that such interventions are both feasible and well-accepted by the local population. For school-age children, computerized cognitive rehabilitation training can be an entertaining and engaging way to improve attention, working memory, and problem solving skills for children with HIV. Further dissemination and implementation science work is needed for arriving at cost-effective strategies for scaling up such behavioral interventions in African resource-constrained settings, given that the vast majority of HIV-affected children and youth worldwide presently live in sub-Saharan Africa.
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Affiliation(s)
- Michael J. Boivin
- Department of Psychiatry and the Department of Neurology & Ophthalmology, Michigan State University Department of Psychiatry, University of Michigan, 909 Fee Road, Rm 321 West Fee Hall, East Lansing Michigan 48894 USA, Phone: 765 506-2163, FAX: 517 432-2893
| | - Horacio Ruisenor-Escudero
- Department of Psychiatry, Michigan State University, 909 Fee Road, Rm 321 West Fee Hall, East Lansing, Michigan 48894 USA, Phone: 517 432-4204, FAX: 517 432-2893
| | - Itziar Familiar-Lopez
- Department of Psychiatry, Michigan State University, 909 Fee Road, Rm 321 West Fee Hall, East Lansing, Michigan 48894 USA, Phone: 517 432-4204, FAX: 517 432-2893
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Funck-Brentano I, Assoumou L, Veber F, Moshous D, Frange P, Blanche S. Resilience and Life Expectations of Perinatally HIV-1 Infected Adolescents in France. Open AIDS J 2016; 10:209-224. [PMID: 27990195 PMCID: PMC5120384 DOI: 10.2174/1874613601610010209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Resilience of perinatally HIV-infected youth in European countries is poorly studied. Life satisfaction and expectations for adulthood are rarely examined. Objective: This cross-sectional, descriptive study of a French cohort of 54 perinatally HIV-infected adolescents raised in France (age 14-20 years) aimed to (1) evaluate their psychosocial adjustment, (2) identify their expectations for adulthood and (3) delineate risk and protective factors associated with mental health, life satisfaction, and HIV-1 viral load level. Method: Medical evaluation, psychological semi-structured interview, and self-report questionnaires were used. Results: All the adolescents had been receiving Highly Active Anti-Retroviral Therapy (HAART) for 9 to 11 years and 2/3 were healthy with controlled viral load (<50 copies/mL). The majority had medium to high levels of life satisfaction. They viewed HIV as having only minor impact on their current daily life and had positive expectations for adulthood. However, 46% exhibited psychiatric symptomatology. Multivariable analysis showed that having a deceased parent and current worries about HIV were substantial risk factors for psychiatric symptoms. Having two living parents and being satisfied with life were protective factors for mental health. Good quality of caregiver-adolescent relationships and high life satisfaction were significant protective factors for controlled viral load. Conclusion: These data indicate psychosocial resilience among perinatally HIV-1 infected adolescents with 10 years of HAART treatment. These findings demonstrate the influence of life satisfaction, parent’s life status and quality of caregiver-adolescent relationships on resilience and health outcomes in these patients. We conclude that healthcare providers should attend to these factors.
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Affiliation(s)
- Isabelle Funck-Brentano
- AP-HP, Hôpital Necker-Enfants Malades, Unité d'Immunologie-hématologie et rhumatologie pédiatriques, 149 rue de Sèvres, 75743 Paris cedex 15, France
| | - Lambert Assoumou
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 45 Boulevard de l'Hôpital, 75013 Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 101 rue de Tolbiac, 75013 Paris, France
| | - Florence Veber
- AP-HP, Hôpital Necker-Enfants Malades, Unité d'Immunologie-hématologie et rhumatologie pédiatriques, 149 rue de Sèvres, 75743 Paris cedex 15, France
| | - Despina Moshous
- AP-HP, Hôpital Necker-Enfants Malades, Unité d'Immunologie-hématologie et rhumatologie pédiatriques, 149 rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, Institut IMAGINE, 24 Boulevard du Montparnasse, 75015 Paris, France
| | - Pierre Frange
- AP-HP, Hôpital Necker-Enfants Malades, Unité d'Immunologie-hématologie et rhumatologie pédiatriques, 149 rue de Sèvres, 75743 Paris cedex 15, France; AP-HP, Hôpital Necker-Enfants Malades, Laboratoire de Microbiologie Clinique; Université Paris Descartes, Sorbonne Paris-Cité, EA 7327, 149 rue de Sèvres 75743 Paris cedex 15, France
| | - Stéphane Blanche
- AP-HP, Hôpital Necker-Enfants Malades, Unité d'Immunologie-hématologie et rhumatologie pédiatriques, 149 rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, Institut IMAGINE, 24 Boulevard du Montparnasse, 75015 Paris, France
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Bass JK, Nakasujja N, Familiar-Lopez I, Sikorskii A, Murray SM, Opoka R, Augustinavicius J, Boivin MJ. Association of caregiver quality of care with neurocognitive outcomes in HIV-affected children aged 2-5 years in Uganda. AIDS Care 2016; 28 Suppl 1:76-83. [PMID: 26888568 PMCID: PMC4820354 DOI: 10.1080/09540121.2016.1146215] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Children affected by HIV are at increased risk of developmental and neuropsychological disturbances due to direct effects of HIV on the brain and direct effects associated with living in poverty. Caregivers can play an important role, through quality caregiving, in mitigating the negative effect of these stressors. This study used baseline data from an ongoing caregiver training intervention trial to evaluate the association between quality of caregiver–child interactions and neurocognitive outcomes in rural HIV-infected and HIV-exposed but uninfected children in Uganda. We also assessed the extent to which caregiver distress moderated this relationship. Data on 329 caregiver–child dyads were collected between March 2012 and July 2014, when the children were between 2 and 5 years of age. Child outcomes include the Mullen Scales of Early Learning to assess general cognitive ability and the Color Object Association Test to assess immediate memory and total recall. Caregiving quality was assessed using the Home Observation for the Measurement of the Environment (HOME) total and subscale scores. Caregiver distress was assessed using the Hopkins Symptom Checklist. General linear regression models assessed the association between the HOME total and subscale scores and child outcomes, with interaction terms used to test moderation by caregiver distress. Total HOME scores were positively and significantly associated with Mullen scores of cognitive ability; HOME acceptance subscale scores were positively and significantly associated with immediate recall scores. No other associations were statistically significant. As hypothesized, there is a strong association between the HOME and Mullen scores of cognitive ability in our study population, such that children who were assessed as living in environments with more stimulation also presented with a higher level of general neurocognitive development. Our results support the view of program guidance for HIV-affected children that suggest family-oriented care with emphasis on parent–child relationships for optimal child development.
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Affiliation(s)
- Judith K Bass
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | | | | | - Alla Sikorskii
- d Department of Statistics and Probability , Michigan State University , East Lansing , MI , USA
| | - Sarah M Murray
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Robert Opoka
- e Department of Paediatrics & Child Health , Makerere University , Kampala , Uganda
| | - Jura Augustinavicius
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Michael J Boivin
- c Department of Psychiatry , Michigan State University , East Lansing , MI , USA
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