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Wu Q, Zhao J, Zhao G, Li X, Du H, Chi P. Long-Term Trajectories of Depressive Symptoms Among Children Affected by Parental HIV: A 12-Year Follow-Up Study. AIDS Behav 2022; 26:2713-2722. [PMID: 35165794 DOI: 10.1007/s10461-021-03572-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 01/07/2023]
Abstract
The present study explored the trajectories of depressive symptoms over 12 years spanning from childhood to emerging adulthood and the between-trajectory differences in psychosocial adjustment among Chinese children (N = 492, 52.8% boys, aged 6 to 18 years at baseline) affected by parental HIV. Rebounding (12.6%), resilient (64.8%), and improving (22.6%) trajectories were identified. Individuals in the rebounding trajectory reported the highest levels of psychological distress and the lowest levels of subjective well-being, positive self-regard, and personal strengths in adulthood. Individuals in the resilient trajectory reported lower levels of psychological distress and negative affect than those in the improving trajectory. The findings support the development of programs by policymakers and practitioners to improve the psychosocial adjustment of children who have been affected by parental HIV while considering individual differences in the trajectories of depressive symptoms.
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Neuropsychological and Psychosocial Functioning of Children with Perinatal HIV-Infection in The Netherlands. Viruses 2021; 13:v13101947. [PMID: 34696375 PMCID: PMC8540320 DOI: 10.3390/v13101947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Advances in antiretroviral treatment improved the life expectancy of perinatally HIV-infected children. However, growing up with HIV provides challenges in daily functioning. This cross-sectional cohort study investigated the neuropsychological and psychosocial functioning of a group of perinatally HIV-infected children in the Netherlands and compared their outcomes with Dutch normative data and outcomes of a control group of uninfected siblings. The children’s functioning was assessed with internationally well-known and standardized questionnaires, using a multi-informant approach, including the perspectives of caregivers, teachers, and school-aged children. In addition, we explored the associations of socio-demographic and medical characteristics of the HIV-infected children with their neuropsychological and psychosocial functioning. Caregivers reported compromised functioning when compared to Dutch normative data for HIV-infected children in the areas of attention, sensory processing, social-emotional functioning, and health-related quality of life. Teachers reported in addition compromised executive functioning for HIV-infected children. A comparison with siblings revealed differences in executive functioning, problems with peers, and general health. The concurrent resemblance between HIV-infected children and siblings regarding problems in other domains implies that social and contextual factors may be of influence. A family-focused approach with special attention to the child’s socio-environmental context and additional attention for siblings is recommended.
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van Opstal SEM, Wagener MN, Miedema HS, Utens EMWJ, Aarsen FK, van der Knaap LC, van Gorp ECM, van Rossum AMC, Roelofs PDDM. School functioning of children with perinatal HIV-infection in high-income countries: A systematic review. PLoS One 2021; 16:e0252746. [PMID: 34086807 PMCID: PMC8177442 DOI: 10.1371/journal.pone.0252746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/22/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Since the introduction of combination antiretroviral therapy, human immunodeficiency virus (HIV) infection is a manageable chronic disease. However, school-age children (4–18 years) living with HIV could still experience problems with functioning at school, due to the impact of the virus itself, medication, comorbidities and social stigma. School functioning covers academic achievement, school attendance, and social relationships and is of utmost importance to optimize normal participation. Methods To gain insight in school functioning problems of perinatally HIV-infected children, we performed a systematic review of the literature in multiple databases from January 1997 up to February 2019. Studies were included if they described outcomes of school functioning of school-age children perinatally infected with HIV, in high-income countries. Meta-analyses were performed for sufficiently comparable studies. Results and discussion Results from 32 studies show that HIV-infected children experience more problems in various areas of school functioning in comparison with national norms, matched healthy controls, siblings and HIV-exposed uninfected (HEU) children. The most pronounced differences concerned the usage of special educational services, general learning problems, and mathematics and reading performance scores. Comparisons with both national norms and siblings/HEU children show that the differences between HIV-infected children and siblings/HEU children were less pronounced. Moreover, siblings/HEU children also reported significantly worse outcomes compared to national norms. This suggests that problems in school functioning cannot be solely attributed to the HIV-infection, but that multiple socio-economic and cultural factors may play a role herein. Conclusion Perinatally HIV-infected children seem vulnerable to problems in various areas of school functioning. Therefore, monitoring of school functioning should be an important aspect in the care for these children. A family-focused approach with special attention to a child’s socio-environmental context and additional attention for siblings and HEU children, is therefore recommended.
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Affiliation(s)
- Stefanie E. M. van Opstal
- Erasmus MC, Department of Viroscience, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- * E-mail:
| | - Marlies N. Wagener
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Harald S. Miedema
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Elisabeth M. W. J. Utens
- Erasmus MC, Department of Child and Adolescent Psychiatry, University Medical Center Rotterdam, Rotterdam, The Netherlands
- The Bascule, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Femke K. Aarsen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Eric C. M. van Gorp
- Erasmus MC, Department of Viroscience, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Pepijn D. D. M. Roelofs
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Too EK, Abubakar A, Nasambu C, Koot HM, Cuijpers P, Newton CRJC, Nyongesa MK. Prevalence and factors associated with common mental disorders in young people living with HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc 2021; 24 Suppl 2:e25705. [PMID: 34164931 PMCID: PMC8222842 DOI: 10.1002/jia2.25705] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Common mental disorders (CMDs) particularly depression and anxiety, are highly comorbid with HIV also in young people living with HIV (YLWH). In sub-Saharan Africa (SSA) where most YLWH reside, there are limited summary data on CMDs among these youths, yet there are previous systematic reviews summarizing data on CMDs among adults living with HIV. We conducted a systematic literature review on the prevalence and correlates of CMDs among YLWH, aged 10 to 24 years, from SSA. METHODS We searched African Index Medicus, African Journals Online and five other electronic databases (from database inception up to 31 December 2020) for relevant studies published in English. The key search terms applied were as follows: "Depression OR Anxiety", "Young people", "HIV infections" and "sub-Saharan Africa". RESULTS AND DISCUSSION Out of 3989 articles, 31 studies were included in the review. The prevalence of CMDs in YLWH widely varied ranging between 16.0% and 40.8% for major depression, 4.4% and 52.6% for depressive symptoms and 2.2% and 25.0% for anxiety symptoms. Anxiety disorder was estimated at 45.6%. Four of the five included studies with a comparison group of HIV-negative young people reported significantly higher prevalence estimates of depressive disorders among YLWH. Several sociodemographic, psychosocial and HIV-related correlates of CMDs were reported but most lacked consensus across studies. Nevertheless, female sex, older age, fewer schooling years, HIV-positive status, bullying, sexual abuse, HIV-related stigma, social support and poor antiretroviral therapy adherence were frequently reported (in ≥2 studies) as significant correlates of depressive symptoms among YLWH. Higher social support was the only frequent significant correlate of anxiety symptoms. CONCLUSIONS The burden of CMDs among YLWH from SSA is substantial and appears to be significantly higher when compared with HIV-negative peers, particularly for depressive disorders. However, more comparative research is needed. Importantly, screening for CMDs at the youth HIV-clinics should be prioritized especially for YLWH at high risk of CMDs, to facilitate early management or referral for treatment. Furthermore, youth-friendly psychological interventions addressing CMDs in YLWH should urgently be piloted in SSA, incorporating contextual components that may directly or indirectly reduce symptoms of CMDs among YLWH, such as social support.
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Affiliation(s)
- Ezra K Too
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of Public HealthPwani UniversityKilifiKenya
| | - Amina Abubakar
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of Public HealthPwani UniversityKilifiKenya
- Department of PsychiatryUniversity of OxfordOxfordUK
- Institute for Human DevelopmentAga Khan UniversityNairobiKenya
| | - Carophine Nasambu
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
| | - Hans M Koot
- Department of ClinicalNeuro‐ and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Pim Cuijpers
- Department of ClinicalNeuro‐ and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Charles RJC Newton
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of Public HealthPwani UniversityKilifiKenya
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Moses K Nyongesa
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of ClinicalNeuro‐ and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
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Ter Haar AM, Van den Hof M, Scherpbier HJ, Oostrom KJ, Haverman L, Pajkrt D. Health-related quality of life of perinatally HIV-infected young people: a longitudinal study. AIDS Care 2021; 34:263-271. [PMID: 33793369 DOI: 10.1080/09540121.2021.1909695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Young people perinatally infected with HIV (pHIV) are at risk of a lowered health-related quality of life (HRQOL). Previous evaluation of the NeurOlogical, VIsual and Cognitive performance in HIV-infected Children (NOVICE)-cohort showed no difference in HRQOL between pHIV and matched HIV-uninfected controls (HIV-), yet a higher percentage of pHIV had impaired HRQOL. The aim of this study is to compare the change over time in HRQOL of pHIV to HIV- over a 5-year period. We used the Pediatric Quality of Life Inventory (PedsQL)™ 4.0 to repeat HRQOL assessment. High PedsQL scores indicate good HRQOL. Fifteen/33 (45.5%) pHIV and 17/37 (45.9%) HIV- completed both assessments. At the first assessment, the mean age was 13.1 years (range 8.0-18.4). PHIV scored higher than HIV- on Emotional functioning and on Total scale score. After five years, the mean age was 17.6 years (range 12.1-22.8). PHIV scored higher than HIV- on all scales, except Social functioning. PHIV did not differ significantly from the Dutch norm on either time-point. LMEM showed no difference in change over time for any of the PedsQL scales. In this study, young people with pHIV receiving high-quality health care, including monitoring of HRQOL, remain to experience a good HRQOL.
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Affiliation(s)
- A M Ter Haar
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, Netherlands
| | - M Van den Hof
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, Netherlands
| | - H J Scherpbier
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, Netherlands
| | - K J Oostrom
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, Department of Child and Adolescent Psychiatry, Pediatric Psychology and Psychosocial Care, University of Amsterdam, Amsterdam, Netherlands
| | - L Haverman
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, Department of Child and Adolescent Psychiatry, Pediatric Psychology and Psychosocial Care, University of Amsterdam, Amsterdam, Netherlands
| | - D Pajkrt
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, Netherlands
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Shiau S, Evans H, Strehlau R, Shen Y, Burke M, Liberty A, Coovadia A, Abrams EJ, Yin MT, Violari A, Kuhn L, Arpadi SM. Behavioral Functioning and Quality of Life in South African Children Living with HIV on Antiretroviral Therapy. J Pediatr 2020; 227:308-313.e2. [PMID: 32712285 PMCID: PMC8811608 DOI: 10.1016/j.jpeds.2020.07.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Abstract
This study examined behavioral functioning and quality of life in South African children living with perinatally acquired HIV. Compared with controls, children living with perinatally acquired HIV had a higher mean total difficulties score assessed by the Strengths and Difficulties Questionnaire and lower mean quality of life scores assessed by the Pediatric Quality of Life Inventory.
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Affiliation(s)
- Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Henry Evans
- Department of Medicine, Division of Infectious Diseases, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yanhan Shen
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elaine J Abrams
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael T Yin
- Department of Medicine, Division of Infectious Diseases, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Avy Violari
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Louise Kuhn
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Stephen M Arpadi
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
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Tuke R, Sikorskii A, Zalwango SK, Webster KD, Ismail A, Pobee RA, Barkin JL, Boivin MJ, Giordani B, Ezeamama AE. Psychosocial Adjustment in Ugandan Children: Coping With Human Immunodeficiency Virus Exposure, Lifetime Adversity, and Importance of Social Support. New Dir Child Adolesc Dev 2020; 2020:55-75. [PMID: 32618425 DOI: 10.1002/cad.20354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cumulative lifetime adversity and social support were investigated as determinants of psychosocial adjustment (esteem, distress, hopefulness, positive outlook/future aspirations, and sense of purpose) over 12 months in 6-10-years-old HIV-infected, HIV-exposed uninfected and HIV-unexposed uninfected children from Uganda. Each determinant and psychosocial adjustment indicator was self-reported using standardized questionnaires administered at baseline, 6, and 12 months. Linear mixed effects models were used to relate time-varying lifetime adversity and social support to psychosocial adjustment over 12 months. Regardless of HIV status, higher adversity predicted lower esteem (coefficient b = -2.98, 95% confidence interval (CI): [-4.62, -1.35]) and increased distress (b =3.96, 95% CI: [1.29, 6.62]) but was not associated with hopefulness, positive outlook or sense of purpose. Low social support predicted higher distress (b =9.05, 95% CI: [7.36, 10.73]), lower positive outlook (b = -10.56, 95% CI: [-2.34, -8.79]) and low sense of purpose (b = -9.90, 95% CI: [-11.44, -8.36]) over 12 months. Pragmatic interventions that enhance coping with adversity and provide emotional/instrumental support should be tested for effectiveness in promoting resilient psychosocial adjustment trajectory in vulnerable children.
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Zielinska-Wieniawska A, Bielecki M, Wolanczyk T, Kruk M, Marczynska M, Srebnicki T, Brynska A. Health-related quality of life in Polish children and adolescents with perinatal HIV infection - short report. AIDS Care 2019; 32:1393-1399. [PMID: 31818123 DOI: 10.1080/09540121.2019.1699641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aims of the study were to assess health-related quality of life (HRQoL) in children and adolescents with perinatal HIV infection and to establish possible relationships with clinical and socio-demographic variables. About 56 children with perinatal HIV infection, aged 6-18 years (PHIV+ group), 24 healthy perinatally HIV-exposed but uninfected (PHEU) children, and 43 children HIV-unexposed uninfected (HUU) were assessed using the PedsQL 4.0. Generic Core. The perceptions of school functioning according to children and social functioning, according to parents, were worse in the PHIV+ group compared to those in the PHEU group. In comparison to the HUU group, PHIV+ children received lower total HRQoL scores in the caregivers' perception. Most of the life-quality indices increased systematically with age in PHIV+ group, whereas opposite trends were present in both control groups. Caregivers of children with a final CDC category C and caregivers of children diagnosed with encephalopathy perceived most domains of their children functioning as more problematic. A more serious course and more severe HIV infection before treatment were associated with worse multidimensional functioning and a worse total HRQoL score. Results highlight the importance of early diagnosis and treatment initiation as having significant implications for the quality of life.
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Affiliation(s)
| | - Maksymilian Bielecki
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Tomasz Wolanczyk
- Department of Child and Adolescent Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Malgorzata Kruk
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw's Hospital for Infectious Diseases, Warsaw, Poland
| | - Magdalena Marczynska
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw's Hospital for Infectious Diseases, Warsaw, Poland
| | - Tomasz Srebnicki
- Department of Child and Adolescent Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Anita Brynska
- Department of Child and Adolescent Psychiatry, Medical University of Warsaw, Warsaw, Poland
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Louthrenoo O, Aurpibul L, Oberdorfer P, Sirisanthana V. Family Functioning in Adolescents with Perinatal HIV Infection. J Int Assoc Provid AIDS Care 2019; 17:2325958218774782. [PMID: 29756549 PMCID: PMC6748494 DOI: 10.1177/2325958218774782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This study aimed to assess family functioning in adolescents with perinatal HIV infection receiving antiretroviral therapy compared with healthy controls. Correlations between self-reported and caregiver-reported family functions were also evaluated. A sample of 195 participants including 65 perinatally HIV-infected adolescents and 130 healthy controls were enrolled. The total family functioning score in HIV-infected adolescents was significantly lower than that in healthy controls by self-report (105.86 vs 115.41; P ≤ .001). Caregivers of HIV-infected adolescents also reported lower scores of family functioning than those of controls (109.91 vs 114.98; P ≤ .001). Among the HIV-infected group, there was no or minimal correlation between the self-reported and caregiver-reported total scores of family functioning. However, there were moderate correlations between self-reported and caregiver-reported family functioning total scores in the control group. Overall, HIV-infected adolescents reported lower family functioning than healthy controls. Improved functioning in the family may help with better adjustment in perinatally HIV-infected adolescents.
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Affiliation(s)
- Orawan Louthrenoo
- 1 Department of Pediatrics, Chiang Mai University, Chiang Mai, Thailand
| | - Linda Aurpibul
- 2 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Virat Sirisanthana
- 2 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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Nestadt DF, Saisaengjan C, McKay MM, Bunupuradah T, Pardo G, Lakhonpon S, Gopalan P, Leu CS, Petdachai W, Kosalaraksa P, Srirompotong U, Ananworanich J, Mellins CA. CHAMP+ Thailand: Pilot Randomized Control Trial of a Family-Based Psychosocial Intervention for Perinatally HIV-Infected Early Adolescents. AIDS Patient Care STDS 2019; 33:227-236. [PMID: 31067121 DOI: 10.1089/apc.2019.0021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Within Asia, HIV prevalence is highest in Thailand, including thousands of children and adolescents. Care for children born with HIV [perinatal transmission of HIV (PHIV)] will need to focus on adolescents for the foreseeable future. Thai PHIV adolescents experience significant mental health and psychosocial challenges, including treatment adherence. Yet, few, if any, comprehensive interventions for them exist. CHAMP+, an evidence-based intervention adapted for Thailand, was evaluated with a pilot randomized control trial at four HIV clinics. Eighty-eight dyads of 9- to 14-year-old PHIV young adolescents/caregivers were randomized to CHAMP+ or standard of care (SOC). Eleven cartoon-based sessions were delivered over 6 months. Participants completed baseline, 6-month (postintervention), and 9-month surveys, measuring youth outcomes (e.g., mental health and adherence), contextual factors (e.g., demographics and caregiver factors), and self- and social-regulation factors (e.g., HIV knowledge and youth-caregiver communication). Multi-level modeling to account for clustering within individuals was used to assess longitudinal changes within and between groups. All families randomized to CHAMP+ completed the intervention. Although the study was not statistically powered to detect differences in treatment effects, the CHAMP+ group significantly improved at 6 months in youth mental health and adherence, HIV knowledge, youth-caregiver communication, internalized stigma, and HIV-related social support, with most improvements sustained at 9 months and significantly better improvements than the SOC group on a number of outcomes. High levels of baseline viral suppression highlight the importance of reaching these young PHIV adolescents at a period of lower risk before adherence and other challenges emerge. Designed to be delivered with limited cost/resources, CHAMP+ Thailand holds scale-up potential.
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Affiliation(s)
- Danielle Friedman Nestadt
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York
| | | | - Mary McKernan McKay
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York, New York
| | | | - Gisselle Pardo
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York, New York
| | | | - Priya Gopalan
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York, New York
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | | | | | | | - Jintanat Ananworanich
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Khon Kaen Hospital, Khon Kaen, Thailand
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatrics, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York
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Le Prevost M, Arenas-Pinto A, Melvin D, Parrott F, Foster C, Ford D, Evangeli M, Winston A, Sturgeon K, Rowson K, Gibb DM, Judd A. Anxiety and depression symptoms in young people with perinatally acquired HIV and HIV affected young people in England. AIDS Care 2018; 30:1040-1049. [PMID: 29502430 PMCID: PMC5989154 DOI: 10.1080/09540121.2018.1441972] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Adolescents with perinatal HIV (PHIV) may be at higher risk of anxiety and depression than HIV negative young people. We investigated prevalence of anxiety and depression symptoms in 283 PHIV and 96 HIV-affected (HIV-negative) young people in England recruited into the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort. We used Hospital Anxiety and Depression Scale (HADS) scores and linear regression investigated predictors of higher (worse) scores.115 (41%) and 29 (30%) PHIV and HIV-affected young people were male, median age was 16 [interquartile range 15,18] and 16 [14,18] years and 241 (85%) and 71 (74%) were black African, respectively. There were no differences in anxiety and depression scores between PHIV and HIV-affected participants. Predictors of higher anxiety scores were a higher number of carers in childhood, speaking a language other than English at home, lower self-esteem, ever thinking life was not worth living and lower social functioning. Predictors of higher depression scores were male sex, death of one/both parents, school exclusion, lower self-esteem and lower social functioning. In conclusion, HIV status was not associated with anxiety or depression scores, but findings highlight the need to identify and support young people at higher risk of anxiety and depression.
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Affiliation(s)
- Marthe Le Prevost
- a MRC Clinical Trials Unit at UCL , University College London , London , UK
| | | | - Diane Melvin
- b Department of Psychology , Imperial College Healthcare NHS Trust , London , UK
| | - Francesca Parrott
- a MRC Clinical Trials Unit at UCL , University College London , London , UK
| | - Caroline Foster
- c The Family and 900 Clinics , Imperial College Healthcare NHS Trust , London , UK
| | - Deborah Ford
- a MRC Clinical Trials Unit at UCL , University College London , London , UK
| | - Michael Evangeli
- d Department of Psychology , Royal Holloway University of London , Surrey , UK
| | - Alan Winston
- e Section of Retrovirology , Imperial College London , London , UK
| | - Kate Sturgeon
- a MRC Clinical Trials Unit at UCL , University College London , London , UK
| | - Katie Rowson
- a MRC Clinical Trials Unit at UCL , University College London , London , UK
| | - Diana M Gibb
- a MRC Clinical Trials Unit at UCL , University College London , London , UK
| | - Ali Judd
- a MRC Clinical Trials Unit at UCL , University College London , London , UK
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- a MRC Clinical Trials Unit at UCL , University College London , London , UK
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Bhana A, Mellins CA, Small L, Nestadt DF, Leu CS, Petersen I, Machanyangwa S, McKay M. Resilience in perinatal HIV+ adolescents in South Africa. AIDS Care 2017; 28 Suppl 2:49-59. [PMID: 27391999 PMCID: PMC4991226 DOI: 10.1080/09540121.2016.1176676] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Increasing numbers of perinatally HIV (PHIV+)-infected youth are surviving into adulthood with better access to treatment. However, few studies examine positive outcomes in the face of adversity (resilience) for PHIV+ youth. Social Action Theory (SAT) provided the theoretical framework for this study of PHIV + youth in South Africa (SA), allowing examination of contextual, social, and self-regulatory factors that influence behavioral health. Data were from youth and caregiver baseline interviews, simply pooled from a pilot (N=66) and larger (n=111) randomized control trial (RCT) of the VUKA Family program. For this analysis, outcomes included emotional and behavioral functioning (total difficulties), and prosocial behaviors. Potential SAT correlates included socio-demographics; caregiver health and mental health; parent-child relationship factors; stigma, and child coping, support; and self-esteem. Regression analyses adjusted for age, gender, and study revealed significant associations at the contextual, social, and self-regulation level. Lower total child difficulties scores were associated with lower caregiver depression (β = 3.906,p < .001), less caregiver-reported communication about difficult issues (β = 1.882, p = .009) and higher youth self-esteem (β = -0.119, p = .020). Greater prosocial behaviors were associated with greater caregiver-reported communication (β = 0.722, p = .020) and child use of wishful thinking for coping (β = 5.532, p = .009). Less youth depression was associated with higher caregiver education (β =−0.399, p = .010), greater caregiver supervision (β = −1.261, p = .012), more social support seeking (β = −0.453, p = .002), higher youth self-esteem (β = −0.067, p < .001), lower internalized stigma (β = 0.608, p = .040), and child use of resignation for coping (β = 1.152, p = .041). Our data support evidence-based family interventions that also promote youth self-regulation skills to enhance the health and mental health of PHIV+ youth.
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Affiliation(s)
- Arvin Bhana
- a SA Medical Research Council , Health Systems Research Unit , Durban , South Africa.,b School of Applied Human Sciences , University of KwaZulu-Natal , Durban , South Africa
| | - Claude A Mellins
- c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - Latoya Small
- d School of Social Work , The University of North Carolina at Chapel Hill , NC , USA
| | - Danielle F Nestadt
- c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - Cheng-Shiun Leu
- c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - Inge Petersen
- b School of Applied Human Sciences , University of KwaZulu-Natal , Durban , South Africa
| | - Sphindile Machanyangwa
- b School of Applied Human Sciences , University of KwaZulu-Natal , Durban , South Africa
| | - Mary McKay
- e Silver School of Social Work , New York University , New York , NY , USA
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Nestadt DF, Lakhonpon S, Pardo G, Saisaengjan C, Gopalan P, Bunupuradah T, McKay MM, Ananworanich J, Mellins CA. A Qualitative Exploration of Psychosocial Challenges of Perinatally HIV-Infected Adolescents and Families in Bangkok, Thailand. VULNERABLE CHILDREN AND YOUTH STUDIES 2017; 13:158-169. [PMID: 30344614 PMCID: PMC6190906 DOI: 10.1080/17450128.2017.1356947] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Thailand has the highest HIV prevalence in Asia, with 9,600 HIV+ adolescents and thousands additional younger HIV+ children (World Bank, 2015; UNICEF, 2015). Studies from other settings suggest perinatally HIV-infected (PHIV+) adolescents are at high risk for mental health problems and engagement in risk behaviors that threaten individual and public health. Yet, few studies exist in Thailand, and few evidence-based psychosocial interventions have been developed for and studied in this population, despite great need. The current study qualitatively explored psychosocial issues among Thai PHIV+ adolescents to inform development or adaptation of interventions. Thai and US-based researchers and clinicians conducted two focus group discussions with PHIV+ adolescents aged 12-16 and their adult caregivers, and six in-depth key informant interviews with health/social work providers at a large clinic for PHIV+ youth in Bangkok, Thailand. Data were analyzed thematically using framework analysis. Multiple challenges for PHIV+ youth and caregivers were identified. Adherence to antiretroviral treatment was a significant challenge attributed to lack of adult support, side effects, feeling too well to take medicines, and avoiding acknowledging sickness. Poor child-caregiver communication and conflict was a key concern, explained in part by cultural expectation of obedience and generation gaps. Concerns about societal stigma and discrimination emerged strongly and influenced delay or avoidance of disclosing HIV status to children and others. Respondents identified positive approaches to addressing these issues and highlighted the need for interventions to improve child-caregiver communication and generate peer and community support for PHIV+ youth. Thai PHIV+ adolescents and families experience significant psychosocial challenges, similar to those seen in other contexts. Cultural adaptation of an existing evidence-based clinic-based family group intervention is recommended to rapidly address these needs.
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Affiliation(s)
- Danielle Friedman Nestadt
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, United States
| | - Sudrak Lakhonpon
- The Children and Youth Program, SEARCH, HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand, +66-2-252-2568-9
| | - Gisselle Pardo
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 41 East 11th Street, 7th Floor, New York, NY 10003, United States, +1-212-998-4300
| | - Chutima Saisaengjan
- The Children and Youth Program, SEARCH, HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand, +66-2-252-2568-9
| | - Priya Gopalan
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 41 East 11th Street, 7th Floor, New York, NY 10003, United States, +1-212-998-4300
| | - Torsak Bunupuradah
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand, +66-2-252-2568-9
| | - Mary McKernan McKay
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 41 East 11th Street, 7th Floor, New York, NY 10003, United States, +1-212-998-4300
| | - Jintanat Ananworanich
- The Children and Youth Program, SEARCH, HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand, +66-2-252-2568-9
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, United States
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Malete L, Mokgatlhe L, Nnyepi M, Jackson J, Wen F, Bennink M, Anabwani G, Makhanda J, Thior I, Lyoka P, Weatherspoon L. Effects of a High Protein Food Supplement on Physical Activity, Motor Performance and Health Related Quality of Life of HIV Infected Botswana Children on Anti-Retroviral Therapy (ART). AIMS Public Health 2017; 4:258-277. [PMID: 29546216 PMCID: PMC5690453 DOI: 10.3934/publichealth.2017.3.258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/19/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Despite existing evidence about the benefits of nutrition, physical activity (PA) and sport to the overall health and wellbeing of children, knowledge gaps remain on this relationship in children living with chronic conditions like HIV/AIDS. Such knowledge should inform context specific programs that could enhance the quality of life of children. The purpose of this study was to examine the effects of integrating a nutrition intervention (culturally tailored food supplement) into antiretroviral therapy (ART) on psychosocial outcomes and physical activity among HIV-positive children in Botswana. Method 201 HIV-positive children (6–15 years; M = 9.44, SD = 2.40) were recruited and randomly assigned (stratified by age and gender) to two groups. The intervention group (n = 97) received a high protein (bean-sorghum plus micronutrients) food supplement, while the control group (n = 104) received a sorghum plus micronutrients supplement. Participants were followed over 12 months. Anthropometric measures, PA, motor performance, and health related quality of life (HRQL) were collected at baseline, 6 and 12 months. Results Mixed repeated-measures ANOVA revealed a significant time effect of the food supplement on target variables except body fat percentage, speed, and school functioning. Time × treatment interaction was found for physical functioning, psychosocial functioning and total quality of life score. Scores on physical functioning and total of quality life in the intervention group significantly increased from baseline to 6 months compared with the control group (p = 0.015). Conclusion A combination of ART and nutritional intervention had a positive effect on physical functioning and total quality of life of HIV-positive children in this study. There were also improvements to physical activity and motor performance tests over time. More research is needed on long term effects of nutrition and PA interventions on HRQL in children living with HIV.
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Affiliation(s)
| | | | | | - Jose Jackson
- Michigan State University, East Lansing, Michigan, USA
| | - Fujun Wen
- Michigan State University, East Lansing, Michigan, USA
| | | | - Gabriel Anabwani
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.,Baylor College of Medicine, Pediatric Retrovirology, Houston, Texas, USA
| | - Jerry Makhanda
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Ibou Thior
- Botswana Harvard Partnership, Gaborone, Botswana
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Nkwata AK, Zalwango SK, Kizza FN, Sekandi JN, Mutanga J, Zhang M, Musoke PM, Ezeamama AE. Quality of life among perinatally HIV-affected and HIV-unaffected school-aged and adolescent Ugandan children: a multi-dimensional assessment of wellbeing in the post-HAART era. Qual Life Res 2017; 26:2397-2408. [PMID: 28534093 DOI: 10.1007/s11136-017-1597-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine quality of life (QOL) in perinatally HIV-infected (PHIV) or HIV-exposed uninfected (PHEU) vs. healthy HIV-unexposed uninfected (HUU) children during school-age/adolescence. METHODS PHIV infection was diagnosed via DNA PCR. Current HIV status was confirmed by HIV rapid diagnostic test. Three HIV groups were defined: PHIV, PHEU, and HUU. QOL was assessed with proxy and self-report versions of the PedsQL™ 4.0 instrument at 6-18 years of age. QOL scores ranged from zero (least QOL) to 100 (highest QOL) in the following dimensions: combined QOL inventory (CQOLI), multi-dimensional vigor (MDV), general wellbeing (GWB), present functioning, and general cognitive functioning (CF). Multivariable linear regression models estimated HIV-related percent differences (β) in QOL scores and 95% confidence intervals (CI). FINDINGS Compared to HUU CQOLI deficits ranged from 6.5 to 9.2% (95% CI -15.4, -1.6), GWB deficit ranged from 6.5 to 10.5% (95% CI -16.0, -1.3), MDV deficit ranged from 6.8 to 11.6% (95% CI -14.5, 0.9), and CF deficit ranged from 9.7 to 13.1% for PHIV children. QOL deficits of similar magnitude and direction in most domains were observed for PHIV compared to PHEU. However, self-reported indicators of GWB (β = -3.5; 95% CI -9.0, 2.0) and present functioning (β = 4.0; 95% CI -4.6, 12.5) were similar for PHIV compared to PHEU. QOL scores were generally similar for PHEU compared to HUU. CONCLUSION PHEU and HUU had similar QOL profile but PHIV predicted sustained deficits in multiple QOL domains. PHIV and PHEU children were similar with respect to general wellbeing and present functioning. Psychosocial and scholastic interventions in combination with HIV care are likely to improve QOL in PHIV.
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Affiliation(s)
- A K Nkwata
- Department of Epidemiology and Biostatistics, The University of Georgia, Athens, GA, USA
| | - S K Zalwango
- Directorate of Public Health and Environment, Kampala Capital City Authority, Kampala, Uganda
| | - F N Kizza
- Division of Health Protection, Office of HIV, Georgia Department of Public Health, Atlanta, GA, USA
| | - J N Sekandi
- Department of Epidemiology and Biostatistics, The University of Georgia, Athens, GA, USA
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - J Mutanga
- Department of Epidemiology and Biostatistics, The University of Georgia, Athens, GA, USA
| | - M Zhang
- Department of Epidemiology and Biostatistics, The University of Georgia, Athens, GA, USA
| | - P M Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - A E Ezeamama
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.
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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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Nutritional and Immunological Correlates of Memory and Neurocognitive Development Among HIV-Infected Children Living in Kayunga, Uganda. J Acquir Immune Defic Syndr 2016; 71:522-9. [PMID: 26605506 DOI: 10.1097/qai.0000000000000905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the nutritional and immunological correlates of memory and neurocognitive development as measured by the Mullen Scales of Early Learning (MSEL) and by the Color Object Association Test (COAT) among children in Uganda. DESIGN This analysis uses baseline data collected between 2008 and 2010 from 119 HIV-infected children aged 1-6 years, participating in a randomized controlled trial of an interventional parenting program in Kayunga, Uganda. METHODS Peripheral blood draws were performed to determine immunological biomarkers. Unadjusted and adjusted linear regression models were used to relate MSEL and COAT scores to sociodemographic characteristics, weight-for-age Z scores (WAZs), antiretroviral therapy status, and immunological biomarkers. RESULTS In the final analysis, 111 children were included. Lower levels of CD4 CD38 T cells (P = 0.04) were associated to higher immediate and total recall scores (P = 0.04). Higher levels of CD8 HLA-DR T cells were associated with higher total recall score (P = 0.04) of the COAT. Higher CD4 CD38 HLA-DR T cells levels were associated with higher gross motor scores of the MSEL (P = 0.02). WAZ was positively correlated to visual reception, fine motor, expressive language, and composite score of the MSEL. CONCLUSIONS Overall, WAZ was a stronger predictor of neurocognitive outcomes assessed by the MSEL. CD4 CD38 T cells were more specifically associated with memory-related outcomes. Future research should include immunological markers and standardized neurocognitive tests to further understand this relationship.
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Psychosocial adjustment in perinatally human immunodeficiency virus infected or exposed children - a Retrospective Cohort Study. J Int AIDS Soc 2016; 19:20694. [PMID: 27341885 PMCID: PMC4920943 DOI: 10.7448/ias.19.1.20694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 04/28/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022] Open
Abstract
Objective To determine whether perinatal HIV infection and exposure adversely affected psychosocial adjustment (PA) between 6 and 18 years of life (i.e. during school-age and adolescence). Methods We enrolled 58 perinatally HIV-infected, 56 HIV-exposed uninfected and 54 unexposed controls from Kampala, Uganda. Perinatal HIV status was determined by 18 months of age using a DNA-polymerase chain-reaction test and was confirmed via HIV rapid diagnostic test at psychosocial testing when the children were 6 to 18 years old. Five indicators of PA (depressive symptoms, distress, hopelessness, positive future orientation and esteem) were measured using validated, culturally adapted and translated instruments. Multivariable linear regression analyses estimated HIV-status-related percent differences (β) in PA indicators and corresponding 95% confidence intervals (CIs). Results During school-age and adolescence, positive outlook (β=−3.8, 95% CI: −7.2, −0.1) and self-esteem (β=−4.3, 95% CI: −6.7, −1.8) scores were significantly lower, whereas depressive (β=11.4, 95% CI: 3.3, 19.5) and distress (β=12.3, 95% CI: 5.9, 18.7) symptoms were elevated for perinatally HIV-infected, compared to unexposed controls and exposed uninfected children. Similarly, positive outlook (β=−4.3, 95% CI: −7.3, −1.2) and self-esteem were lower for exposed controls versus HIV-unexposed children. Hopelessness was similar by perinatal HIV status. Likewise, the distress and depressive symptom levels were comparable for HIV-exposed uninfected and HIV-unexposed children. Conclusions Perinatal HIV infection predicted higher distress and depressive symptoms, while HIV-affected status (infection/exposure) predicted low self-esteem and diminished positive outlook in the long term. However, HIV-affected status had no impact on hopelessness, suggesting that psychosocial interventions as an integral component of HIV care for infected children or primary care exposed uninfected children may improve PA and quality of life in these vulnerable groups.
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A Prospective Longitudinal Study of Mental Health Symptoms Among Perinatally HIV-Infected and HIV-Exposed but Uninfected Urban Youths. J Adolesc Health 2016; 58:460-466. [PMID: 26873611 PMCID: PMC4808472 DOI: 10.1016/j.jadohealth.2015.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/15/2015] [Accepted: 12/16/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Significant gaps persist in our understanding of the etiological factors that shape the progression of mental health symptoms (MHS) among perinatally HIV-infected (PHIV+) and perinatally HIV-exposed but uninfected (PHEU) youths. This study sought to assess the changes in MHS among PHIV+ and PHEU youths as they transition through adolescence and to identify the associated psychosocial factors. METHODS Data were drawn from a longitudinal study of 166 PHIV+ and 114 PHEU youths (49% male, ages 9-16 years at baseline) in New York City. Individual interviews were administered at baseline and subsequently over a 5-year period. MHS were assessed using the youth version of the Diagnostic Interview Schedule for Children. Predictive growth curve analyses were conducted to assess longitudinal changes in MHS and identify the relevant factors. Level I predictors included: time, major life events, household poverty, caregiver mental health, and neighborhood stressors. Level II predictors included youths' sociodemographic characteristics (e.g., age, gender, HIV status) and baseline future orientation scores. RESULTS The changes in youths' MHS followed a quadratic growth curve and were positively associated with the number of major negative life events and neighborhood stressors experienced. Youths' HIV status, household poverty, and caregiver mental health were not significantly associated with youths' MHS. CONCLUSIONS Findings suggest that irrespective of youths' HIV status, major life events and neighborhood stressors increase MHS among PHIV+ and PHEU youths. There is a need for interventions to reduce the impact of stressors on the mental well-being of PHIV+ and PHEU youths.
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Vreeman RC, Scanlon ML, McHenry MS, Nyandiko WM. The physical and psychological effects of HIV infection and its treatment on perinatally HIV-infected children. J Int AIDS Soc 2015; 18:20258. [PMID: 26639114 PMCID: PMC4670835 DOI: 10.7448/ias.18.7.20258] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/25/2015] [Accepted: 09/02/2015] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION As highly active antiretroviral therapy (HAART) transforms human immunodeficiency virus (HIV) into a manageable chronic disease, new challenges are emerging in treating children born with HIV, including a number of risks to their physical and psychological health due to HIV infection and its lifelong treatment. METHODS We conducted a literature review to evaluate the evidence on the physical and psychological effects of perinatal HIV (PHIV+) infection and its treatment in the era of HAART, including major chronic comorbidities. RESULTS AND DISCUSSION Perinatally infected children face concerning levels of treatment failure and drug resistance, which may hamper their long-term treatment and result in more significant comorbidities. Physical complications from PHIV+ infection and treatment potentially affect all major organ systems. Although treatment with antiretroviral (ARV) therapy has reduced incidence of severe neurocognitive diseases like HIV encephalopathy, perinatally infected children may experience less severe neurocognitive complications related to HIV disease and ARV neurotoxicity. Major metabolic complications include dyslipidaemia and insulin resistance, complications that are associated with both HIV infection and several ARV agents and may significantly affect cardiovascular disease risk with age. Bone abnormalities, particularly amongst children treated with tenofovir, are a concern for perinatally infected children who may be at higher risk for bone fractures and osteoporosis. In many studies, rates of anaemia are significantly higher for HIV-infected children. Renal failure is a significant complication and cause of death amongst perinatally infected children, while new data on sexual and reproductive health suggest that sexually transmitted infections and birth complications may be additional concerns for perinatally infected children in adolescence. Finally, perinatally infected children may face psychological challenges, including higher rates of mental health and behavioural disorders. Existing studies have significant methodological limitations, including small sample sizes, inappropriate control groups and heterogeneous definitions, to name a few. CONCLUSIONS Success in treating perinatally HIV-infected children and better understanding of the physical and psychological implications of lifelong HIV infection require that we address a new set of challenges for children. A better understanding of these challenges will guide care providers, researchers and policymakers towards more effective HIV care management for perinatally infected children and their transition to adulthood.
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Affiliation(s)
- Rachel C Vreeman
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya;
| | - Michael L Scanlon
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Megan S McHenry
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Winstone M Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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Mbalinda SN, Kiwanuka N, Kaye DK, Eriksson LE. Reproductive health and lifestyle factors associated with health-related quality of life among perinatally HIV-infected adolescents in Uganda. Health Qual Life Outcomes 2015; 13:170. [PMID: 26490047 PMCID: PMC4618375 DOI: 10.1186/s12955-015-0366-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/14/2015] [Indexed: 01/14/2023] Open
Abstract
Background With increased survival of perinatally HIV - infected adolescents due to antiretroviral therapy (ART), the focus of HIV care has shifted to health-related quality of life (HRQoL) as a measure of disease progression, effects of ART co-morbidity and prognosis. We assessed factors associated with better HRQoL in perinatally HIV -infected adolescents in Uganda by determining the associations between sexual and reproductive health (SRH) or lifestyle experiences on HRQoL. Methods In a cross-sectional study, data on SRH, lifestyle experiences, socio demographic factors, communication with parents on sexuality and satisfaction of SRH services in ART clinics were collected from 614 HIV perinatally infected adolescents aged 10–19 using an interviewer-administered survey questionnaire. HRQoL data were collected using the Medical Outcomes Study HIV Health Survey instrument (MOS-HIV). Factors associated with better HRQoL were analysed using multiple logistic regression. Results The mean age was 16.2 ± 2.1 years, 362 (58.8 %) were females and 210 (34.2 %) were sexually active. Adolescents on ART were twice likely to present with better physical health (AOR = 2.07, 95 % CI: 1.24–3.46) and four times more likely to present with better mental health (AOR = 3.9, 95 % CI: 2.22–6.92) than those who were not on ART. There were no statistically significant associations between SRH (ever had sex, ever been pregnant, condom use, contraceptive use) or life style factors and physical health or mental health. Those with secondary or tertiary education were more likely to present with a better mental health (AOR = 5.3, 95 % CI: 1.86–15.41) compared those who had attained primary or no education. Participants who desired to have a child in future more likely (AOR 1.7, 95 % CI: 1.05–3.00) to present with a better mental health. Lack of communication with guardians on sexuality (AOR = 0.6, 95 % CI: 0.40–0.89), or dissatisfaction with SRH services (AOR 0.34, 95 % CI: 0.18–0.62) were associated with poorer mental health. Conclusion Among perinatally HIV-infected adolescents in Uganda, being on ART was associated with better physical and mental health while lack of communication with guardians on sexuality or dissatisfaction with SRH services was associated with poor mental health. Adolescents with pregnancy intentions were more likely to have a better mental health.
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Affiliation(s)
- Scovia Nalugo Mbalinda
- Department of Nursing, School of Health Sciences, Makerere University, P.O.Box 7072, Kampala, Uganda.
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Dan K Kaye
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. .,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. .,School of Health Sciences, City University London, London, UK.
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23
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Cohen S, ter Stege JA, Weijsenfeld AM, van der Plas A, Kuijpers TW, Reiss P, Scherpbier HJ, Haverman L, Pajkrt D. Health-related quality of life in perinatally HIV-infected children in the Netherlands. AIDS Care 2015; 27:1279-88. [PMID: 26272357 DOI: 10.1080/09540121.2015.1050986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Combination antiretroviral therapy (cART) can alter HIV infection in children into a chronic condition. Studies investigating health-related quality of life (HRQoL) in HIV-infected children are scarce, and lacking from Western Europe. This study aimed to compare the HRQoL of clinically stable perinatally HIV-infected children to healthy, socioeconomically (SES)-matched controls as well as the Dutch norm population, and to explore associations between HIV and cART-related factors with HRQoL. HIV-infected and healthy children aged 8-18 years completed the Pediatric Quality of Life Inventory™ 4.0 (PedsQL™). We determined differences between groups on PedsQL™ mean scores, and the proportion of children with an impaired HRQoL per group (≥1 SD lower than the Dutch norm population). Logistic regression models were used to explore associations between disease-related factors and HRQoL impairment. In total, 33 HIV-infected and 37 healthy children were included. There were no differences in the mean PedsQL™ subscales between HIV-infected children and both control groups. The proportion of children with an impaired HRQoL was higher in the HIV-infected group (27%) as compared to the healthy control group (22%) and the Dutch norm (14%) on the school functioning subscale (HIV vs. Dutch norm: P = .045). Mean scores of HRQoL of perinatally HIV-infected children in the Netherlands were not different from a SES-matched control group, or from the Dutch norm population. However, the HIV-infected group did contain more children with HRQoL impairment, suggesting that HIV-infected children in the Netherlands are still more vulnerable to a compromised HRQoL.
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Affiliation(s)
- Sophie Cohen
- a Department of Paediatric Hematology, Immunology, and Infectious Diseases , Emma Children's Hospital, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Jacqueline A ter Stege
- a Department of Paediatric Hematology, Immunology, and Infectious Diseases , Emma Children's Hospital, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.,b Psychosocial Department , Emma Children's Hospital, Academic Medical Center , The Netherlands
| | - Annouschka M Weijsenfeld
- a Department of Paediatric Hematology, Immunology, and Infectious Diseases , Emma Children's Hospital, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Atie van der Plas
- a Department of Paediatric Hematology, Immunology, and Infectious Diseases , Emma Children's Hospital, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Taco W Kuijpers
- a Department of Paediatric Hematology, Immunology, and Infectious Diseases , Emma Children's Hospital, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Peter Reiss
- c Department of Internal Medicine, Division of Infectious Diseases , Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center , Amsterdam , The Netherlands.,d Department of Global Health , Academic Medical Center, University of Amsterdam, and Amsterdam Institute of Global Health and Development , Amsterdam , The Netherlands.,e Amsterdam Institute of Global Health and Development , Amsterdam , The Netherlands.,f HIV Monitoring Foundation , Amsterdam , The Netherlands
| | - Henriette J Scherpbier
- a Department of Paediatric Hematology, Immunology, and Infectious Diseases , Emma Children's Hospital, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Lotte Haverman
- b Psychosocial Department , Emma Children's Hospital, Academic Medical Center , The Netherlands
| | - Dasja Pajkrt
- a Department of Paediatric Hematology, Immunology, and Infectious Diseases , Emma Children's Hospital, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
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24
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Ruiseñor-Escudero H, Familiar I, Nakasujja N, Bangirana P, Opoka R, Giordani B, Boivin M. Immunological correlates of behavioral problems in school-aged children living with HIV in Kayunga, Uganda. Glob Ment Health (Camb) 2015; 2:e9. [PMID: 28596857 PMCID: PMC5269635 DOI: 10.1017/gmh.2015.7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 02/18/2015] [Accepted: 04/15/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HIV can affect the neuropsychological function of children, including their behavior. We aim to identify immunological correlates of behavioral problems among children living with HIV in Uganda. METHODS Children participating in a parent randomized control trial in Kayunga, Uganda were assessed with the Behavior Rating Inventory of Executive Function (BRIEF) and the Child Behavior Checklist (CBCL). We constructed simple and multiple linear regression models to identify immunological correlates of behavioral problems. RESULTS A total of 144 children living with HIV (50% male) with a mean age of 8.9 years [Standard Deviation (s.d.) = 1.9] were included in the analysis. Eighty-two children were on antiretroviral therapy. Mean CD4 cell count % was 35.1 cells/μl (s.d. = 15.0), mean CD4 cell activation 5.7% (s.d. = 5.1), mean CD8 cell activation was 17.5% (s.d. = 11.2) and 60 children (41.7%) had a viral load of <4000 copies/ml. In the adjusted models for the BRIEF, higher scores were associated with higher viral loads (aβ = 16.7 × 10-6, 95% CI -5.00 × 10-6 to 28.4 × 10-6), specifically on the behavioral regulation index. Higher mean CD8 activation % was associated with higher scores on the Externalizing Problems and Total Problems scales of the CBCL (aβ = 0.17, 95% CI 0.04-0.31 and aβ = 0.15, 95% CI 0.00-0.28, respectively). CONCLUSIONS Poorer behavioral outcomes were associated with higher viral loads while higher CD8 activation was associated with poorer emotional and behavioral outcomes. Complete immunological assessments for children living with HIV could include commonly used viral and immunological parameters to identify those at higher risk of having negative behavior outcomes and who would benefit the most from behavioral interventions.
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Affiliation(s)
- H. Ruiseñor-Escudero
- Department of Psychiatry, East Lansing, Michigan State University, Michigan, USA
| | - I. Familiar
- Department of Psychiatry, East Lansing, Michigan State University, Michigan, USA
| | - N. Nakasujja
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - P. Bangirana
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - R. Opoka
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - B. Giordani
- Department of Psychiatry, University of Michigan, Michigan, USA
| | - M. Boivin
- Department of Psychiatry, East Lansing, Michigan State University, Michigan, USA
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25
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De Santis JP, Garcia A, Chaparro A, Beltran O. Integration versus disintegration: a grounded theory study of adolescent and young adult development in the context of perinatally-acquired HIV infection. J Pediatr Nurs 2014; 29:422-35. [PMID: 24486128 PMCID: PMC4096608 DOI: 10.1016/j.pedn.2014.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 01/07/2014] [Accepted: 01/07/2014] [Indexed: 11/18/2022]
Abstract
Adolescents/young adults with perinatally-acquired HIV infection experience a number of issues that impact developmental tasks. No study to date has described the process by which this occurs. The purpose of this grounded theory study was to describe the process by which HIV infection impacts adolescent/young adult development. Interviews were conducted and analyzed with 25 participants age 18 to 24. Six core categories emerged that were used to generate a theory, integration versus disintegration, that describes how perinatal HIV impacts participants' development. The results of this study provide unique clinical considerations for pediatric and adult clinicians providing care for this population.
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Affiliation(s)
- Joseph P De Santis
- University of Miami School of Nursing & Health Studies, Coral Gables, FL.
| | - Ana Garcia
- University of Miami Miller School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Miami, FL
| | - Aida Chaparro
- University of Miami Miller School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Miami, FL
| | - Oscar Beltran
- University of Texas at El Paso College of Health Sciences/School of Nursing, El Paso, TX
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26
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Mellins CA, Nestadt D, Bhana A, Petersen I, Abrams EJ, Alicea S, Holst H, Myeza N, John S, Small L, McKay M. Adapting Evidence-Based Interventions to Meet the Needs of Adolescents Growing Up with HIV in South Africa: The VUKA Case Example. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2014; 1:97-110. [PMID: 25984440 PMCID: PMC4431642 DOI: 10.1007/s40609-014-0023-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The VUKA family program is one of the only evidence-based interventions to promote positive psychosocial outcomes in South African HIV-infected pre- and early adolescents and their families. In this paper, we discuss the collaborative process by which a multidisciplinary team of clinicians, researchers, counselors, and artists/educators and families adapted and developed VUKA for this population using community-based participatory research methods. We describe the intervention and explore lessons learned that may be applicable across contexts related to international collaboration and adapting evidence-based interventions so that they are likely to be acceptable, feasible, and effective in a given setting and country context.
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Affiliation(s)
- Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Danielle Nestadt
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Arvin Bhana
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Inge Petersen
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health, New York, Columbia University, New York, NY, USA, Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Stacey Alicea
- Department of Applied Psychology, New York University, New York, NY, USA
| | | | | | | | - Latoya Small
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA
| | - Mary McKay
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA
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27
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Smith R, Wilkins M. Perinatally acquired HIV infection: long-term neuropsychological consequences and challenges ahead. Child Neuropsychol 2014; 21:234-68. [PMID: 24697320 DOI: 10.1080/09297049.2014.898744] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Over the past three decades, perinatal HIV infection in the United States has evolved from a fatal disease to a manageable chronic illness. As the majority of youth with perinatal HIV infection age into adolescence and adulthood, management of this stigmatizing, transmittable disease in the backdrop of a cadre of environmental stressors presents challenges beyond those of other chronic illnesses. The neurologic and neuropsychological consequences of this neurotropic virus have important implications for the successful navigation of responsibilities related to increasingly independent living of this aging population. This article will review the neurologic and neuropsychological consequences of perinatal HIV infection and concomitant factors in the era of highly active antiretroviral therapy and will provide an overview of the neuropathology, pathogenesis, neuroimaging findings, and treatment of perinatal HIV infection, as well as recommendations for service provision and future research.
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Affiliation(s)
- Renee Smith
- a Department of Pediatrics , University of Illinois at Chicago , Chicago IL , USA
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28
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Bunupuradah T, Kosalaraksa P, Vibol U, Hansudewechakul R, Sophonphan J, Kanjanavanit S, Ngampiyaskul C, Wongsawat J, Luesomboon W, Vonthanak S, Ananworanich J, Ruxrungtham K, Puthanakit, on behalf of the PREDIC T. Impact of antiretroviral therapy on quality of life in HIV-infected Southeast Asian children in the PREDICT study. AIDS Patient Care STDS 2013; 27:596-603. [PMID: 24191673 DOI: 10.1089/apc.2013.0203] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Quality of life (QOL) is an important antiretroviral treatment (ART) outcome. We compared QOL among 299 Thai and Cambodian children ages 1-12 years-old, CD4 15-24% randomized to early (ART at week 0, N=149) versus deferred groups (ART when at CD4 <15%, N=150) and also compared with QOL data from age-matched healthy controls (N=275). Primary caregivers completed PACTG QOL questionnaires at week 0 and every 24 weeks until 144 weeks. Children were enrolled during March 2006 to September 2008. Mean (SD) age of children was 6.3 (2.8) years, 58% were female, 60% were Thai, %CDC N:A:B:C was 2:62:36:0%. During 144 weeks, all children in the early-group and 69 (46%) of deferred-group children started ART. There was no significant difference of QOL scores between treatment groups at baseline (all p>0.05) and at week 144 (all p>0.05). By multivariate analysis, the early-group had higher QOL score changes in five domains, including health perception (p=0.04), physical resilience (p=0.02), psychosocial well-being (p=0.04), social and role functioning (p<0.01), and symptoms (p=0.01) compared to the deferred group. QOL of HIV-infected children in both groups were lower than healthy control in all 7 domains at baseline (all p<0.05) and 5 of 7 domains at weeks 144 (p<0.01). In conclusion, no significant difference of QOL scores between treatment groups. Early ART commencement associated with greater increase of QOL scores over 144 weeks. QOL scores in HIV-infected children were lower than healthy controls.
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Affiliation(s)
- Torsak Bunupuradah
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | | | - Ung Vibol
- National Center for HIV/AIDS, Dermatology and STDs (NCHADS), Phnom Penh, Cambodia
| | | | - Jiratchaya Sophonphan
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | | | | | - Jurai Wongsawat
- Bamrasnaradura Infectious Disease Institute, Nonthaburi, Thailand
| | | | - Saphonn Vonthanak
- National Center for HIV/AIDS, Dermatology and STDs (NCHADS), Phnom Penh, Cambodia
| | - Jintanat Ananworanich
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- SEARCH, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kiat Ruxrungtham
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanyawee Puthanakit, on behalf of the PREDIC
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand
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29
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Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges. J Int AIDS Soc 2013; 16:18593. [PMID: 23782478 PMCID: PMC3687078 DOI: 10.7448/ias.16.1.18593] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/10/2013] [Accepted: 04/16/2013] [Indexed: 12/22/2022] Open
Abstract
Introduction Across the globe, children born with perinatal HIV infection (PHIV) are reaching adolescence and young adulthood in large numbers. The majority of research has focused on biomedical outcomes yet there is increasing awareness that long-term survivors with PHIV are at high risk for mental health problems, given genetic, biomedical, familial and environmental risk. This article presents a review of the literature on the mental health functioning of perinatally HIV-infected (PHIV+) adolescents, corresponding risk and protective factors, treatment modalities and critical needs for future interventions and research. Methods An extensive review of online databases was conducted. Articles including: (1) PHIV+ youth; (2) age 10 and older; (3) mental health outcomes; and (4) mental health treatment were reviewed. Of 93 articles identified, 38 met inclusion criteria, the vast majority from the United States and Europe. Results These studies suggest that PHIV+ youth experience emotional and behavioural problems, including psychiatric disorders, at higher than expected rates, often exceeding those of the general population and other high-risk groups. Yet, the specific role of HIV per se remains unclear, as uninfected youth with HIV exposure or those living in HIV-affected households displayed similar prevalence rates in some studies, higher rates in others and lower rates in still others. Although studies are limited with mixed findings, this review indicates that child-health status, cognitive function, parental health and mental health, stressful life events and neighbourhood disorder have been associated with worse mental health outcomes, while parent–child involvement and communication, and peer, parent and teacher social support have been associated with better function. Few evidence-based interventions exist; CHAMP+, a mental health programme for PHIV+ youth, shows promise across cultures. Conclusions This review highlights research limitations that preclude both conclusions and full understanding of aetiology. Conversely, these limitations present opportunities for future research. Many PHIV+ youth experience adequate mental health despite vulnerabilities. However, the focus of research to date highlights the identification of risks rather than positive attributes, which could inform preventive interventions. Development and evaluation of mental health interventions and preventions are urgently needed to optimize mental health, particularly for PHIV+ youth growing up in low-and-middle income countries.
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30
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Louthrenoo O, Oberdorfer P, Sirisanthana V. Psychosocial functioning in adolescents with perinatal HIV infection receiving highly active antiretroviral therapy. J Int Assoc Provid AIDS Care 2013; 13:178-83. [PMID: 23722084 DOI: 10.1177/2325957413488171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With effective highly active antiretroviral therapy (HAART), perinatally HIV-infected children are living longer through adolescence. METHODS We conducted a cross-sectional study of perinatally HIV-infected adolescents, aged 11 to 18 years. Demographically matched controls were also enrolled. The adolescents completed the Youth Self-Report (YSR), while the caregivers filled out the Child Behavior Checklist (CBCL), to determine emotional and behavioral problems. RESULTS The sample included 50 HIV-infected adolescents and 56 controls. The internalizing problem scores from the YSR were significantly higher in the HIV-infected group than those in the control group (13.76 versus 9.95, P = .02). The total competence scores, from both the self-report and the caregiver report in the HIV-infected group, were significantly lower than those of the control group (P = .005 and .001). CONCLUSION Although HAART has prolonged the survival of HIV-infected children, they remain at increased risk of psychosocial problems as well as impaired social functioning.
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31
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Bunupuradah T, Puthanakit T, Kosalaraksa P, Kerr SJ, Kariminia A, Hansudewechakul R, Kanjanavanit S, Ngampiyaskul C, Wongsawat J, Luesomboon W, Chuenyam T, Vonthanak S, Vun MC, Vibol U, Vannary B, Ruxrungtham K, Ananworanich J. Poor quality of life among untreated Thai and Cambodian children without severe HIV symptoms. AIDS Care 2011; 24:30-8. [PMID: 21777076 DOI: 10.1080/09540121.2011.592815] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There are limited data on quality of life (QOL) 1 in untreated HIV-infected children who do not have severe HIV symptoms. Moreover, such data do not exist for Asian children. Poor QOL could be a factor in deciding if antiretroviral therapy (ART) should be initiated. Thai and Cambodian children (n=294), aged 1-11 years, naïve to ART, with mild to moderate HIV symptoms and CD4 15-24% were enrolled. Their caregivers completed the Pediatric AIDS Clinical Trials Group QOL questionnaire prior to ART commencement. Six QOL domains were assessed using transformed scores that ranged from 0 to 100. Higher QOL scores indicated better health. Mean age was 6.1 (SD 2.8) years, mean CD4 was 723 (SD 369) cells/mm(3), 57% was female, and%CDC N:A:B was 2:63:35%. One-third knew their HIV diagnosis. Mean (SD) scores were 69.9 (17.6) for health perception, 64.5 (16.2) for physical resilience, 84.2 (15.6) for physical functioning, 77.9 (16.3) for psychosocial well-being, 74.7 (28.7) for social and role functioning, 90.0 (12.1) for health care utilization, and 87.4 (11.3) for symptoms domains. Children with CD4 counts above the 2008 World Health Organization (WHO) ART-initiation criteria (n=53) had higher scores in health perception and health care utilization than those with lower CD4 values. Younger children had poorer QOL than older children despite having similar mean CD4%. In conclusion, untreated Asian children without severe HIV symptoms had relatively low QOL scores compared to published reports in Western countries. Therapy initiation criteria by the WHO identified children with lower QOL scores to start ART; however, children who did not fit ART-initiation criteria and those who were younger also displayed poor QOL. QOL assessment should be considered in untreated children to inform decisions about when to initiate ART.
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Affiliation(s)
- Torsak Bunupuradah
- HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
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