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

Abstract

Objective Early childhood development (ECD) programs typically combine healthy nutrition and cognitive stimulation in an integrated model. We separately delivered these two components in a cluster randomized controlled trial (RCT) to evaluate their comparative effectiveness in promoting healthy child development and caregiver mental health. This is the first study to do so for HIV-affected children and their infected mothers,. Methods 221 HIV-exposed but uninfected (HEU) child (2 to 3 years old) and caregiver dyads in 18 geographic clusters in Eastern Uganda were randomized by cluster to receive biweekly individualized sessions of either 1) Mediational Intervention for Sensitizing Caregivers (MISC) training emphasizing cognitive stimulation, or 2) Uganda Community Based Association for Child Welfare program that delivered (UCOBAC) health and nutrition training. Children were evaluated at baseline, six months, one year (training conclusion), and one-year post-training with the Mullen Scales of Early Learning (MSEL), the Color-Object Association Test (COAT) for memory, the Early Childhood Vigilance Test (ECVT) of attention, and the Behavior Rating Inventory of Executive Function (BRIEF-parent). The Caldwell HOME was completed by observers to gauge caregiving quality after training. Caregiver depression/anxiety (Hopkins Symptom Checklist-25) and functionality (list of activities of daily living) were also evaluated. Data collectors were blinded to trial arm assignment. Results MISC resulted in significantly better quality of caregiving compared to UCOBAC mid-intervention with an adjusted mean difference (MadjDiff ) of 2.34 (95% CI: 1.54, 3.15, p<0.01), post intervention (MadjDiff=2.43, 95% CI: 1.61, 3.25, p<0.01) and at one year follow-up (MadjDiff=2.07, 95% CI: 1.23, 2.90, p<0.01). MISC caregivers reported more problems on the BRIEF for their child at one-year post-training only (p<0.01). Caregiving quality (HOME) was significantly correlated with MSEL composite performance one-year post training for both the MISC and the UCOBAC trial arms. Likewise, physical growth was significantly related to child development outcomes even though it did not differ between trial arms. Conclusions Even though MISC demonstrated an advantage of improving caregiving quality, it did not produce better child cognitive outcomes compared to health and nutrition training.

Do effects of early life interventions on linear growth correspond to effects on neurobehavioural development? A systematic review and meta-analysis

“…51 studies provided nutritional supplementation 12-62 and 14 studies promoted responsive care and learning oppor tunities. 42,48,[63][64][65][66][67][68][69][70][71][72][73][74] These were the only two categories of intervention that were provided by five or more studies; therefore, analyses of pooled effect sizes focused on these two categories of intervention. Other interventions were water, sanitation, and hygiene (4 studies), 22,23,61,75 cash transfer (2 studies), 76,77 nutrition education (3 studies), 72,78,79 variation of the timing of maternal delivery by caesarean section (1 study), 80 foster care (1 study), 81 provision of antibiotics during pregnancy (1 study), 82 vaccination (1 study), 83 thyroxine supplementation in children with Down syndrome (1 study), 84 provision of nitric oxide to preterm infants (1 study), 85 and newborn erythropoietin treatment (1 study).…”

Early child development in children who are HIV‐exposed uninfected compared to children who are HIV‐unexposed: observational sub‐study of a cluster‐randomized trial in rural Zimbabwe

“…In SHINE, compared to HIV‐negative women, those who were HIV‐positive had more depression, a well‐documented determinant of poor infant neurodevelopmental outcomes which may have mediated the effect of maternal HIV infection on ECD outcomes. However, notably, a caregiver training intervention did not improve neurodevelopment among CHEU in a cluster‐randomized trial in Uganda, despite improving the quality of caregiving . Third, HIV‐specific biomedical factors may contribute to neurodevelopmental impairment, including effects of the virus itself, immunosuppression, co‐infections (including CMV ), and ART.…”

Low risk of neurodevelopmental impairment among perinatally acquired HIV‐infected preschool children who received early antiretroviral treatment in Thailand

“…Children are taught basic skills and knowledge through creative play and social interaction. Both home‐based and school‐based interventions could improve early childhood neurodevelopmental functioning by providing increased opportunities for developmental stimulation and learning . Even though growth parameters were significantly lower in PHIV children, they were not associated with developmental outcomes.…”