Psychomotor functioning of HIV positive adolescents on antiretroviral treatment in Johannesburg, South Africa.
Date
2014-02-25
Authors
MacIlwaine, Stephanie
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Abstract
In 2009 an estimated 33 million people were living with the Human Immunodeficiency Virus
(HIV). Of this global population, 35% live in South Africa. Furthermore, sub-Saharan Africa
is home to 80% of the world’s population of HIV-1 positive children and adolescents. The
most prominent form of transmission of HIV in children in South Africa is from mother to
child. Until 2004, South Africans had limited access to ARV treatment at and after birth due
to the government legislation. As a consequence, treatment of HIV in children may only have
been initiated after clinical presentation of immune deficiency. Therefore, currently, HIV-1
positive adolescents born during the period of restricted ARV-access may have experienced
physical and developmental symptoms associated with the virus including neurological
deficits, prior to initiating treatment. This study investigated the current psychomotor
functioning, such as psychomotor speed, manual dexterity, graphomotor and visual-motor
coordination of a group of low socio-economic HIV-1 positive adolescents in Johannesburg,
South Africa, who are now on a managed antiretroviral programme and how this compared to
a HIV negative contrast group. A Mann-Whitney U Test indicated a significant difference in
mean non-dominant hand performance in the Grooved Pegboard Test between the two groups
(U = 738, p < .05), with the HIV positive group performing slower than the HIV negative
group. An independent samples t-test indicated a significant difference between groups in the
Block Design subtest of the WISC-R [t(88) = -2.93, p < .01] where the HIV positive group
performed significantly worse than the HIV negative group. Additionally, a Mann-Whitney U
Test revealed a significant difference in number of errors made in the WISC-R Mazes subtest
between groups (U = 736.50, p < .05), where the HIV negative group made more errors.
Another Mann-Whitney U Test revealed a significant difference between groups in the
ROCFT Copy score (U = 534.50, p < .01) where the HIV positive group achieved a
significantly lower score than the HIV negative group. Lastly, a Mann-Whitney U Test
demonstrated significant differences between the groups in the Trail Making Test A time (U
= 445.00, p < .01), Trail Making Test B time (U = 509.00, p < .01), the number of errors
made on the Trail Making Test B (U = 729.00, p < .05) and the difference between Trail
Making Test B – A time (U = 769.50, p < .05) with the HIV positive group performing
slower and making more errors in Part B than the contrast group. The findings of the current
study imply that HIV-1 vertically-infected adolescents in Johannesburg, South Africa, on a
delayed HAART programme appear to have persisting difficulties in complex psychomotor
skills where an integration of functions is required. Furthermore, these results indicate an
overall poor psychomotor performance in comparison to international normative data,
supporting previous findings. Developmental, remedial and therapeutic recommendations
were made.