Association of caregiver quality of care with neurocognitive outcomes in HIV-affected children aged 2–5 years in Uganda

Abstract

Children affected by HIV are at increased risk of developmental and neuropsychological disturbances due to direct effects of HIV on the brain and direct effects associated with living in poverty. Caregivers can play an important role, through quality caregiving, in mitigating the negative effect of these stressors. This study used baseline data from an ongoing caregiver training intervention trial to evaluate the association between quality of caregiver–child interactions and neurocognitive outcomes in rural HIV-infected and HIV-exposed but uninfected children in Uganda. We also assessed the extent to which caregiver distress moderated this relationship. Data on 329 caregiver–child dyads were collected between March 2012 and July 2014, when the children were between 2 and 5 years of age. Child outcomes include the Mullen Scales of Early Learning to assess general cognitive ability and the Color Object Association Test to assess immediate memory and total recall. Caregiving quality was assessed using the Home Observation for the Measurement of the Environment (HOME) total and subscale scores. Caregiver distress was assessed using the Hopkins Symptom Checklist. General linear regression models assessed the association between the HOME total and subscale scores and child outcomes, with interaction terms used to test moderation by caregiver distress. Total HOME scores were positively and significantly associated with Mullen scores of cognitive ability; HOME acceptance subscale scores were positively and significantly associated with immediate recall scores. No other associations were statistically significant. As hypothesized, there is a strong association between the HOME and Mullen scores of cognitive ability in our study population, such that children who were assessed as living in environments with more stimulation also presented with a higher level of general neurocognitive development. Our results support the view of program guidance for HIV-affected children that suggest family-oriented care with emphasis on parent–child relationships for optimal child development.

Socio-demographic correlates of depression and anxiety among female caregivers living with HIV in rural Uganda

“…Details of the parent study are described elsewhere (Bass, Nakasujja, Familiar-Lopez, Sikorskii, Murray,…& Boivin, 2016). Briefly, inclusion criteria for caregivers were being female, aged 18 or older, predominantly taking care of a child aged 2–5 years (median age=3 years), and willing and able to participate in a year of MISC training.…”

Effect of Caregiver Training on the Neurodevelopment of HIV-Exposed Uninfected Children and Caregiver Mental Health: A Ugandan Cluster-Randomized Controlled Trial

“…Caregivers in this context have described a complex interrelationship between their well-being and their children’s, in which caring for children who are unwell was seen as interfering with one’s ability to provide for the child and their family. 34, 50, 51 For mothers whose caregiving duties are made complicated by living with the physical, economic, and social effects of HIV, this is an especially important benefit of an ECD intervention.…”

“…Improved functionality, especially for mothers coping with HIV disease, can mediate the benefits of improved caregiving on child development, as has been documented in an earlier report. 34, 50, 51 Therefore, it is important to monitor the mental health benefits of caregiver training interventions as important potential mediators of how such training might enhance the development of at-risk children.…”

“…In addition, the lack of a long-term post-intervention follow up assessments limits our inferences about the relative effects of these two interventions to the early childhood period. Given prior findings in this setting on the association of poor caregiving quality with neurocognitive developmental deficits among HIV-affected children, 34 an important avenue of further research is whether or not the significant effect of MISC on caregiving quality in the short term may mediate longer-term improvements in child developmental trajectories.…”

“…32, 33 They have also provided measures of child development related to quality of caregiving at baseline in the present study cohort. 34 The present child development assessments have also proven sensitive to the effects of severe malaria in Ugandan children. 35, 36 …”