Neurodevelopmental intervention in early-treated HIV-infected children
Date
2021
Authors
Strehlau, Renate
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Abstract
It has been estimated that more than 200 million children under the age of five years in low- and
middle-income countries are at risk of not reaching their developmental potential, with the largest
at-risk population residing in sub-Saharan Africa. A multitude of biopsychosocial risks have been
implicated in poor short- and long-term developmental outcomes, most notably: poverty, stunting
and infection with the Human Immunodeficiency Virus (HIV).
Infection of an infant with HIV can result in significant neurological damage. The use of paediatric
antiretroviral therapy (ART) has reduced the frequency of HIV-related adverse neurological and
neurodevelopmental sequelae. However, children living with HIV infection and those uninfected
but exposed to HIV, face cumulative hurdles as in Africa HIV is often accompanied with economic
and social disparity.
Evidence has demonstrated the importance of the early childhood period for the acquisition of
cognitive, motor, language, perceptual, socio-emotional and self-regulation abilities which are
foundational for future academic and economic competencies as well as human capital
achievements over the life course. The proven benefits of early stimulatory interventions on
developmental outcomes resulted in the inclusion of access to quality early childhood development
programmes as a Sustainable Development Goal in an attempt to promote the development of
underprivileged children.
As part of this study a scoping review investigating interventions which have been used to mitigate
or prevent neurodevelopmental delays in children exposed to or infected with HIV, was conducted.
The existing evidence mapped out by the review revealed a wide variation in the type, duration
and intensity of interventions. Of the ten studies included in the review only one investigated an
intervention which focused specifically on stimulating child development in young children
infected with HIV through a home-based stimulation programme.
This study was designed as a non-randomised controlled intervention study aimed to describe
neurodevelopment at 12 months of age in three distinct groups, namely: an observational, an
intervention and a control group, using a multi-dimensional diagnostic test – the Bayley Scales of
Infant and Toddler Development III-edition (BSID-III), in an urban centre in Johannesburg, South
Africa. The observational and intervention group (IG) consisted of children with perinatally
acquired HIV infection who started ART within the first month of life, in addition children in the
IG participated in a year-long developmental stimulation programme; HIV-exposed uninfected
children made up the control group. Children in the observational group (OG) who were older than
one year at the time of study start were assessed when 24 or 36 months old.
Compared with the test reference mean, the 12 month BSID-III assessment scores of children in
all three groups were encouraging. Children with perinatal HIV infection in the IG displayed a
trend towards higher BSID-III mean composite scores in the cognitive, language and motor sub scales, compared with OG children: 105 (SD 128) vs. 103 (SD 9), p=0.5252; 105.2 (SD 11.1) vs.
100 (17), p=0.1904; 99.5 (SD 9.24) vs. 99 (SD 11), p=0.8705, respectively. BSID-III scores were
lower in children assessed at 24 and 36 months of age.
Despite early diagnosis and treatment, children infected with HIV are still at risk of poor
developmental outcomes – secondary to both HIV infection and underlying social determinants of
health. Strengthening health services to ensure mothers and children receive a comprehensive
package including an early stimulation programme will help children infected with HIV to achieve
their developmental potential.
Description
A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2021