School functioning of children with perinatal HIV-infection in high-income countries: A systematic review

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.

Disclosure of HIV Status to Children on Antiretroviral Therapy: Perspectives and Experiences of Healthcare Providers in the Masaka Region, Uganda

“…Child schooling and visitations, particularly children in boarding schools and those who take long visitations to grandparents' and aunts' places, negatively in uenced the receipt of disclosure of their HIV diagnosis. The negative nding about boarding schools discon rms previous studies in Kenya [47], Brazil [50], and the Western world [51]. Thus, more research is needed to document the school HIV management systems for caring for children living with HIV in this and similar settings.…”

Generalist medical artificial intelligence: Embracing the future with flexible interactions

“…Moreover, as Opstal et al suggest that, when discussing the locus of this neuropsychological problem, it is necessary to consider not only HIV infection but also different aspects of socio-economic and cultural factors. 7 The study also demonstrated the possibility of conducting neuropsychological assessments with children infected with HIV through MTCT using age-appropriate neuropsychological tests. Standardized testing tools for infants and children need to be developed to facilitate investigating the long-term neuropsychological prognosis of children infected through MTCT of HIV by comparing them with adults.…”

Neuropsychological and Psychosocial Functioning of Children with Perinatal HIV-Infection in The Netherlands

“…In addition, considering the potential neuropsychological and psychosocial challenges, it is not surprising that HIV-infected children may have difficulties in school functioning. Studies report on learning problems, drop-outs, the need for extra support at school, and enrollment in fulltime special education [11][12][13]. Education is universally recognized to be essential for children's development; for HIV-infected children, education is specifically important to provide a sense of normalcy and to reduce risk behavior [14].…”