Interventions Addressing Neurodevelopmental Delay in Young Children Infected With and Exposed to HIV: A Scoping Review

An interprofessional model of care for adolescents with perinatal HIV: A qualitative study

Background and Aims

The number of perinatally HIV-infected adolescents (PHIVA) is increasing however many health care systems are not prepared for this population and their health challenges, specifically a model of care (MoC) is lacking. Thus the objective of this study was to develop and propose a MoC for PHIVA.

Methods

Through a qualitative study design, a MoC was developed and ratified with two focus groups, consisting of PHIVA and healthcare professionals.

Results

Seven participants were included in each focus group and the following themes were developed: relatable attributes; missing components; implementation and suggestions. Changes were made to the drafts of the MoC in response to the focus group results, leading to the finalisation of a MoC for PHIVA. The MoC focused on the importance of interprofessional health care and addressed the physical sequelae that PHIVA are likely to encounter. A schematic of the MoC was created for the use in general public education.

Conclusion

It is important that healthcare facilities are equipped to handle the specific needs of PHIVA. The interprofessional MoC developed in this study helps to address the requirements of this population.

Physical functioning in adolescents with perinatal HIV

Perinatal HIV impacts on growth and development in childhood, with physical impairments such as growth limitations, decreased physical activity, reduced exercise tolerance and cardiopulmonary dysfunction continuing into adolescence. There is limited data on other physical functioning domains in perinatally HIV-infected adolescents (PHIVA) thus the aim of this study was to establish the physical sequelae of perinatal HIV in adolescents. This South African cross-sectional study compared PHIVA with HIV-negative adolescents, assessing anthropometry, muscle strength, endurance and motor performance. All ethical considerations were adhered to. The study included 147 PHIVA and 102 HIV-negative adolescents, aged 10-16 years. The majority (87.1%) of PHIVA were virally suppressed however, they still showed significant deficits in height (p < 0.001), weight (p < 0.001) and BMI (p = 0.004). Both groups performed poorly in muscle strength and endurance but did not differ significantly. In motor performance, the PHIVA scored significantly lower for manual dexterity and balance, with significantly more PHIVA with motor difficulty. A regression analysis showed that viral suppression predicted muscle strength (p = 0.032) and age positively predicted endurance (p = 0.044) and negatively predicated aiming and catching (p = 0.009). In conclusion, PHIVA face growth deficits and challenges with motor performance, especially with manual dexterity and balance.

Physical sequelae of growing into adolescence with perinatally acquired HIV: a scoping review protocol

OBJECTIVE

This scoping review aims to identify and describe the physical sequelae experienced by adolescents with perinatally acquired HIV.

INTRODUCTION

Perinatally acquired HIV is a prevalent condition affecting adolescents. It results in neurocognitive dysfunction and mental health challenges. Data show that some of the physical challenges facing this population include stunted growth and delayed puberty; however, other physical challenges remain largely unknown.

INCLUSION CRITERIA

This review will consider studies that include adolescents aged 10 to 19 years, with perinatally (vertically) acquired HIV. Adolescents from any geographic area, of any ethnicity or socioeconomic background will be considered. The concepts included will be all physical sequelae of perinatally acquired HIV. Studies of any research design, including quantitative, qualitative, and mixed methods, as well as systematic reviews, will be considered.

METHODS

This review will utilize a three-step search strategy. There will be an initial search of MEDLINE (PubMed), followed by a full search of MEDLINE (PubMed), PEDro, CINAHL (EBSCO), Scopus (Elsevier), ScienceDirect (Elsevier), and Google Scholar. Gray literature will be searched using CDC Stacks and OpenGrey. Lastly, the reference lists of all articles will be checked for additional studies. Titles and abstracts will be screened by two independent reviewers against the inclusion criteria, and a third reviewer will resolve any discrepancies. Results will be charted on a data extraction tool and presented with a table, diagrammatic representation, and a descriptive narrative.

Neurodevelopment in early treated HIV-infected infants participating in a developmental stimulation programme compared with controls

BACKGROUND

Neurodevelopmental stimulation programmes can improve developmental outcomes. Antiretroviral therapy (ART) started soon after birth potentially limits the invasion of HIV into the central nervous system. A combination of developmental stimulation and early ART initiation may reduce developmental delays in children with perinatally acquired HIV infection.

METHODS

At a single site in Johannesburg, South Africa, we enrolled 36 HIV-infected neonates on ART into an intervention group (IG) participating in a yearlong home-based, neurodevelopmental stimulation programme. Bayley Scales of Infant and Toddler Development-3rd Edition (BSID-III) assessments were conducted at 12 months. Scores were compared with 24 early treated HIV-infected infants in an observational group (OG). BSID-III assessments were also conducted for older children in an OG at 24 or 36 months. Cognitive, language and motor scaled and composite scores were analysed.

RESULTS

BSID-III scaled and composite scores were all higher in the IG apart from the gross motor scaled score (9.25 vs. 10, p = 0.1954). Receptive communication scaled score was significantly higher in the IG (10.96 vs. 9, p = 0.0331). IG composite scores were all higher than OG scores. OG children assessed at 24 or 36 months had lower composite scores in all subscales than 12-month OG scores.

CONCLUSIONS

Early treated HIV-infected children participating in a neurodevelopmental stimulation programme achieved higher BSID-III scores at 12 months compared with early treated HIV-infected children who did not receive the programme.