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Objective As antiretroviral treatment (ART) expands for HIV-infected children, it is important to determine its impact on growth. We quantify growth and its determinants following ART in resource-limited (RLS) and developed settings (DS). Design Systematic review and meta-analysis. Methods We searched publications reporting growth [weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) Z-scores] in HIV-infected children following ART through August 2014. Inclusion criteria: 1) <18 years; 2) ART; 3) sample ≥20; 4) growth at ART; 5) post-ART growth. Standardized and overall weighted mean differences were calculated using random-effects-models. Results Sixty-seven articles were eligible (RLS=54; DS=13). Mean age was 5.8 years, and comparable between settings (P=0.90). Baseline growth was substantially lower in RLS versus DS (WAZ −2.1 vs. −0.5; HAZ −2.2 vs. −0.9; both P<0.01). Rate of weight but not height reconstitution during 12- and 24-months was higher in RLS (12-month WAZ change 0.84 vs. 0.17, P<0.01). Growth deficits persisted in RLS after 2-years ART (P=0.04). Younger cohort age was associated with greater growth reconstitution. PI and NNRTI regimens yielded comparable growth. Adjusting for age and setting, cohorts with nutritional supplements had greater growth gains (24-month rate difference: WAZ 0.55, P=0.03; HAZ 0.60, P=0.007). Supplement benefits were attenuated after adjusting for baseline cohort growth. Conclusions RLS children had substantial growth deficits compared to DS counterparts at ART; growth shortfalls in RLS persisted despite reconstitution. Earlier age and nutritional supplementation at ART may improve growth outcomes. Scant data on supplementation limits evaluation of impact and underscores need for systematic data collection regarding supplementation in pediatric ART programs/cohorts.

Although several interventions resulted in improved child development outcomes for children aged 0 to 3 years, comparison across studies and interventions is limited by use of different outcome measures, time of evaluation, and variability of results.

BACKGROUND AND OBJECTIVES: Opioid-exposed infants frequently qualify for early intervention (EI). However, many eligible families choose not to enroll in this voluntary service. This study aims to understand the perceptions and experiences that may impact engagement with, and the potential benefits of, EI services among mothers in recovery from opioid use disorders (OUDs). METHODS: We conducted semistructured qualitative interviews (n = 22) and 1 focus group (n = 6) with mothers in recovery from OUDs in western Massachusetts. Transcripts were coded and analyzed by using a descriptive approach. RESULTS: The mean participant age was 32 years, and 13 had a high school degree or less. Five major themes emerged revealing mothers’ development through stages of engagement in EI services: (1) fear, guilt, and shame related to drug use (emotions acting as barriers to enrollment); (2) the question of whether it is “needed” (deciding whether there is value in EI for opioid-exposed infants); (3) starting with “judgment” (baseline level of perceived stigma that parents in recovery associate with EI); (4) breaking down the “wall” (how parents overcome the fear and perceived judgment to build partnerships with providers); and (5) “above and beyond” (need for a personal connection with mothers and concrete supports through EI in addition to the child-focused services provided). CONCLUSIONS: Barriers to engagement in EI among mothers in recovery from OUDs include a range of emotions, perceived stigma, and ambivalence. An effort to purposefully listen to and care for mothers through a strengths-based, bigenerational approach may help establish greater connections and foster stronger EI engagement among families affected by OUDs.