The impact of health programmes to prevent vertical transmission of HIV. Advances, emerging health challenges and research priorities for children exposed to or living with HIV: Perspectives from South Africa

Goga, Ameena; Slogrove, Amy L.; Wedderburn, Catherine J.; Feucht, Ute Dagmar; Wessels, Jeannette; Ramokolo, Vundli; Bhana, Arvin; Plessis, N. Du; Green, R.J.; Pillay, Yogan; Sherman, Gayle

doi:10.7196/samj.2019.v109i11b.14292

Cited by 13 publications

(14 citation statements)

References 81 publications

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“…In this study, all children, by definition, were vulnerable—living in HIV infected or affected families. The needs of HIV exposed and uninfected children have emerged [ 59 ], and these children will represent future groups as treatment impacts to reduce mother to child transmission [ 60 ]. Despite the availability of grants, many children did not receive them.…”

Section: Discussionmentioning

confidence: 99%

Food Should not be Forgotten: Impacts of Combined Cash Transfer Receipt and Food Security on Child Education and Cognition in South Africa and Malawi

et al. 2021

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Social protection can take many forms. Both cash transfers and food security may have important contributions to child cognitive development. This study examines the potential impact of combinations of cash transfers and food security status on child cognitive development and educational outcomes. Cross-sectional data for 796 HIV-affected children in the Child Community Care study were utilised for this analysis. Children and caregivers completed interview schedules comprised of standardised items on socio-demographics, household data, cash grant receipt and food security status, school achievement, and cognition. A series of logistic and linear regression models and marginal effects analyses were undertaken to explore the impacts of differing levels of social protection (none; either cash grant receipt or food secure status or, both in combination) on child educational and cognitive outcomes. Although all children lived in poverty-stricken households, 20% (157/796) of children did not live in a household in receipt of a cash grant and did not report food security; 32.4% (258/796) reported either component of social protection and, 47.9% (381/796) received both measures of social protection in combination. Compared to no social protection, being in receipt of either component of social protection was found to be significantly associated with being in the correct class for age, higher scores of non-verbal cognition, and higher working memory scores. Receiving both social protection measures in combination was found to be significantly associated with reduced educational risk scores, improved odds of being in the correct class for age, regular school attendance, missing less than a week of school in the previous two weeks, higher scores on measures of nonverbal cognition, higher working memory scores, and learning new things more easily. Educational and cognitive outcomes for children can be bolstered by social protection measures (cash grant receipt or food security). Benefits are enhanced when social protection is received in combination. Such findings support the notion of synergistic social protection responses for children living in environments impacted by high levels of HIV burden and deprivation.

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Section: Discussionmentioning

confidence: 99%

Food Should not be Forgotten: Impacts of Combined Cash Transfer Receipt and Food Security on Child Education and Cognition in South Africa and Malawi

et al. 2021

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“…More accurate evaluation of the health risks and needs of children HEU, particularly in resource-limited settings, is a research priority [27,28]. Much of the existing evidence of infectious morbidity in infants HEU predates the era of universal maternal ART.…”

Section: Introductionmentioning

confidence: 99%

Increased infectious-cause hospitalization among infants who are HIV-exposed uninfected compared with HIV-unexposed

Anderson¹,

Kalk²,

Madlala

et al. 2021

Aids

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Objectives: Increased risk of morbidity and hospitalization has been observed in children who are HIV-exposed uninfected (HEU) compared with HIV-unexposed uninfected (HUU). Studies in the era of universal maternal antiretroviral treatment (ART) are limited.Design: Prospective cohort. Methods:We investigated hospitalization between 29 days and 12 months of life in a South African cohort of infants born between February 2017 and January 2019 (HEU ¼ 455; HUU ¼ 458). All mothers known with HIV during pregnancy received ART. We reviewed hospital records and classified and graded infectious diagnoses using a standardized tool. We examined factors associated with infectious-cause hospitalization using mixed-effects Poisson regression.Results: Infants HEU vs. HUU had higher all-cause and infectious-cause hospitalization (13 vs. 7%, P ¼ 0.004 and 10 vs. 6%, P ¼ 0.014, respectively). Infectious causes accounted for most hospitalizations (77%). More infants HEU were hospitalized with severe or very severe infections than those HUU (9 vs. 6%; P ¼ 0.031). Mortality (<1%) did not differ between groups. HIV exposure was a significant risk factor for infectious-cause hospitalization [adjusted incidence rate ratios (aIRRs) ¼ 2.8; 95% confidence interval (CI) 1.5-5.4]. Although increased incidence of preterm birth (14 vs. 10%; P < 0.05) and shorter duration of breastfeeding (44 vs. 68% breastfed for !3 months, P < 0.001) among infants HEU vs. HUU contributed to increased hospitalization, they did not account for all the increased risk. Conclusion:Infectious-cause hospitalization incidence was higher among infants HEU vs. HUU, likely partly because of higher incidence of preterm birth and lower breastfeeding rates among infants HEU. The increased infectious disease burden in HEU infants has important implications for health services in sub-Saharan Africa.

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“…[3] The rollout of interventions to prevent mother-to-child transmission (PMTCT) of HIV and increased provision of ART to HIV-infected individuals has contributed to the decline in pneumonia cases. [4] Furthermore, following introduction of pneumococcal conjugate vaccine (PCV) into the SA public immunisation programme in 2009, PCV immunisation was estimated to have reduced under-5 hospitalisations for all-cause pneumonia by 33% and 39% in HIVuninfected and HIV-infected children, respectively, by 2014. [5] Invasive pneumococcal disease has also declined by 69% among children <2 years, including an 89% reduction in PCV7 serotypes and a 57% reduction in PCV13 serotypes in 2012.…”

Section: Epidemiologymentioning

confidence: 99%

“…Pneumonia remains a major cause of morbidity and death in SA children. 4. Risk factors for pneumonia hospitalisation include: HIV infection, HIV exposure (predominantly in infants), young age (particularly those <4 months), premature birth, incomplete immunisation, maternal smoking or household tobacco smoke exposure, indoor air pollution, low birthweight, malnutrition, non-exclusive breastfeeding and overcrowding.…”

Section: A Reduction In Vertical Transmission Of Hiv Increased Provimentioning

confidence: 99%

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

Zar

Moore

Andronikou

et al. 2020

Afr J Thorac Crit Care Med

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Background. Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. Objective. To produce revised guidelines for pneumonia in South African children under 5 years of age. Methods. The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. Recommendations. Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. Validation. The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.

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The impact of health programmes to prevent vertical transmission of HIV. Advances, emerging health challenges and research priorities for children exposed to or living with HIV: Perspectives from South Africa

Cited by 13 publications

References 81 publications

Food Should not be Forgotten: Impacts of Combined Cash Transfer Receipt and Food Security on Child Education and Cognition in South Africa and Malawi

Food Should not be Forgotten: Impacts of Combined Cash Transfer Receipt and Food Security on Child Education and Cognition in South Africa and Malawi

Increased infectious-cause hospitalization among infants who are HIV-exposed uninfected compared with HIV-unexposed

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

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