TY - JOUR
T1 - Early child development in children who are HIV-exposed uninfected compared to children who are HIV-unexposed
T2 - observational sub-study of a cluster-randomized trial in rural Zimbabwe
AU - the SHINE Trial Team
AU - Ntozini, Robert
AU - Chandna, Jaya
AU - Evans, Ceri
AU - Chasekwa, Bernard
AU - Majo, Florence D.
AU - Kandawasvika, Gwendoline
AU - Tavengwa, Naume V.
AU - Mutasa, Batsirai
AU - Mutasa, Kuda
AU - Moulton, Lawrence H.
AU - Humphrey, Jean H.
AU - Gladstone, Melissa J.
AU - Prendergast, Andrew J.
N1 - Funding Information:
The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); Department for International Development (DFID), UK; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation (SDC); National Institutes of Health, USA (2R01HD060338-06); and UNICEF (PCA-2017-0002). Role of funder: Study funders approved the trial design, but were not involved in data collection, analysis, or interpretation, nor decisions related to publication. The corresponding author had full access to all study data and ultimate responsibility for the decision to submit for publication. We thank all the mothers, babies and their families who participated in SHINE. We gratefully acknowledge the leadership and staff of the Ministry of Health and Child Care in Chirumanzu and Shurugwi districts and Midlands Province (especially Environmental Health, Nursing, and Nutrition) for their roles in operationalization of the study procedures. We acknowledge the Ministry of Local Government officials in each district who supported and facilitated field operations. We are particularly indebted to Phillipa Rambanepasi and her team for proficiently managing all the finances and Virginia Sauramba and her team for managing all the regulatory and compliance issues. Finally, we are very thankful for our programme officers at the Bill & Melinda Gates Foundation and UK Aid who enthusiastically worked with us over a long period of time to make SHINE happen.
Funding Information:
The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); Department for International Development (DFID), UK; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation (SDC); National Institutes of Health, USA (2R01HD060338‐06); and UNICEF (PCA‐2017‐0002). Role of funder: Study funders approved the trial design, but were not involved in data collection, analysis, or interpretation, nor decisions related to publication. The corresponding author had full access to all study data and ultimate responsibility for the decision to submit for publication.
Publisher Copyright:
© 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Introduction: Exposure to maternal HIV may affect early child development (ECD), although previous studies have reported heterogeneous findings. We evaluated ECD among children who were HIV-exposed uninfected (CHEU) and children who were HIV-unexposed (CHU) recruited to the SHINE trial in rural Zimbabwe. Methods: SHINE was a community-based cluster-randomized trial of improved infant feeding and/or improved water, sanitation and hygiene. Pregnant women were enrolled between 2012 and 2015. We assessed ECD in a sub-study at 24 months of age, between 2016 and 2017, using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social development); MacArthur-Bates Communicative Development Inventory (CDI) (assessing vocabulary and grammar); A-not-B test (assessing object permanence); and a self-control task. Mothers and infants were tested longitudinally for HIV. We used generalized estimating equations to compare ECD scores between CHEU and CHU, accounting for the cluster-randomized design. Primary results were adjusted for trial-related factors that could affect measurement reliability of ECD: study nurse, age of child, calendar month of birth, sex and randomized arm. Results: A total of 205 CHEU and 1175 CHU were evaluated. Mean total MDAT score was 90.6 (SD 8.7) in CHEU compared to 92.4 (9.1) in CHU (adjusted mean difference −1.3, 95% CI: −2.3, −0.3), driven mostly by differences in gross motor (−0.5, 95% CI: −0.9, −0.2) and language scores (−0.6, 95% CI: −1.1, −0.1). There was evidence that fine motor scores were lower in CHEU (adjusted mean difference −0.4, 95% CI: −0.8, 0.0) but no evidence of a difference in social scores (0.1, 95% CI: −0.2, 0.4). Mean MacArthur-Bates CDI vocabulary score was 57.9 (SD 19.2) in CHEU compared to 61.3 (18.8) in CHU (adjusted mean difference −2.9 words, 95% CI: −5.7, −0.1). Object permanence and self-control scores were similar between groups. Conclusions: CHEU in rural Zimbabwe had total child development and vocabulary scores that were approximately 0.15 standard deviations lower than CHU at two years of age. More detailed and specific studies are now needed to unravel the reasons for developmental delay in CHEU and the likelihood that these delays persist in the longer term.
AB - Introduction: Exposure to maternal HIV may affect early child development (ECD), although previous studies have reported heterogeneous findings. We evaluated ECD among children who were HIV-exposed uninfected (CHEU) and children who were HIV-unexposed (CHU) recruited to the SHINE trial in rural Zimbabwe. Methods: SHINE was a community-based cluster-randomized trial of improved infant feeding and/or improved water, sanitation and hygiene. Pregnant women were enrolled between 2012 and 2015. We assessed ECD in a sub-study at 24 months of age, between 2016 and 2017, using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social development); MacArthur-Bates Communicative Development Inventory (CDI) (assessing vocabulary and grammar); A-not-B test (assessing object permanence); and a self-control task. Mothers and infants were tested longitudinally for HIV. We used generalized estimating equations to compare ECD scores between CHEU and CHU, accounting for the cluster-randomized design. Primary results were adjusted for trial-related factors that could affect measurement reliability of ECD: study nurse, age of child, calendar month of birth, sex and randomized arm. Results: A total of 205 CHEU and 1175 CHU were evaluated. Mean total MDAT score was 90.6 (SD 8.7) in CHEU compared to 92.4 (9.1) in CHU (adjusted mean difference −1.3, 95% CI: −2.3, −0.3), driven mostly by differences in gross motor (−0.5, 95% CI: −0.9, −0.2) and language scores (−0.6, 95% CI: −1.1, −0.1). There was evidence that fine motor scores were lower in CHEU (adjusted mean difference −0.4, 95% CI: −0.8, 0.0) but no evidence of a difference in social scores (0.1, 95% CI: −0.2, 0.4). Mean MacArthur-Bates CDI vocabulary score was 57.9 (SD 19.2) in CHEU compared to 61.3 (18.8) in CHU (adjusted mean difference −2.9 words, 95% CI: −5.7, −0.1). Object permanence and self-control scores were similar between groups. Conclusions: CHEU in rural Zimbabwe had total child development and vocabulary scores that were approximately 0.15 standard deviations lower than CHU at two years of age. More detailed and specific studies are now needed to unravel the reasons for developmental delay in CHEU and the likelihood that these delays persist in the longer term.
KW - HIV-exposed uninfected
KW - Zimbabwe
KW - child development
KW - language
KW - motor
KW - self-control
UR - http://www.scopus.com/inward/record.url?scp=85084721579&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85084721579&partnerID=8YFLogxK
U2 - 10.1002/jia2.25456
DO - 10.1002/jia2.25456
M3 - Article
C2 - 32386127
AN - SCOPUS:85084721579
SN - 1758-2652
VL - 23
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 5
M1 - e25456
ER -