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Ezeamama, Amara E.; Zalwango, Sarah K.; Tuke, Robert; Pad, Ricki Lauren; Boivin, Michael J.; Musoke, Philippa M.; Giordani, Bruno; Sikorskii, Alla
doi: 10.1002/cad.20355pmid: 32662113
Caregiver's and child's self‐reported quality of life (QOL) was defined using standardized questionnaires in a sample (N = 277) of 6–10 years old HIV‐infected, HIV‐exposed uninfected, and HIV‐unexposed uninfected children from Uganda. Psychosocial stress (acute stress and cumulative lifetime adversity) and physiologic stress (dysregulations across 13 biomarkers), perinatal HIV status, and their interaction were related to child QOL via general linear models. Lower child‐ and caregiver‐reported psychosocial stress were dose‐dependently associated with higher QOL (acute stress: mean difference coefficient b = 8.1–14.8, effect size [ES] = 0.46–0.83). Lower allostasis was dose‐dependently associated with higher QOL (b = 6.1–9.7, ES = 0.34–0.54). Given low caregiver acute stress, QOL for HIV‐infected was similar to HIV‐uninfected children; however, given high caregiver acute stress, a QOL disadvantage (b = −7.8, 95% CI: −12.8, −2.8; ES = −0.73) was evident for HIV‐infected versus uninfected children. Testing of caregiver stress reduction interventions is warranted to increase wellbeing in dependent children.
Gruver, Rachel S.; Mall, Sumaya; Kvalsvig, Jane D.; Knox, Justin R.; Mellins, Claude A.; Desmond, Chris; Kauchali, Shuaib; Arpadi, Stephen M.; Taylor, Myra; Davidson, Leslie L.
doi: 10.1002/cad.20351pmid:
Tuke, Robert; Sikorskii, Alla; Zalwango, Sarah K.; Webster, Kyle D.; Ismail, Alexander; Pobee, Ruth A.; Barkin, Jennifer L.; Boivin, Michael J.; Giordani, Bruno; Ezeamama, Amara E.
doi: 10.1002/cad.20354pmid:
Penner, Francesca; Sharp, Carla; Marais, Lochner; Shohet, Cilly; Givon, Deborah; Boivin, Michael
doi: 10.1002/cad.20352pmid: 32618434
The goal of this paper was to conduct a review of studies from 2008 to 2019 that evaluated community‐based caregiver or family interventions to support the mental health of orphans and vulnerable children (OVC) in sub‐Saharan Africa, across four domains: (a) study methodology, (b) cultural adaptation and community participation, (c) intervention strategies, and (d) effects on child mental health. Ten interventions were identified. Findings revealed that the majority of studies used a randomized controlled trial or quasi‐experimental design, but few conducted long‐term follow‐up; that all programs undertook cultural adaptation of the intervention using community participatory methods, or were locally developed; that the majority of interventions targeted caregiving behavior and/or caregiver–child relationships using behavioral and cognitive‐behavioral strategies, or were home visiting interventions; and that interventions had mixed effects on OVC mental health. Progress and gaps revealed by these findings are discussed, as are suggestions for possible new directions in this area of intervention science.
Tan, Mei; Bowers, Megan; Thuma, Phil; Grigorenko, Elena L.
doi: 10.1002/cad.20353pmid: 32657046
Efavirenz (EFV) is a well‐known, effective anti‐retroviral drug long used in first‐line treatment for children and adults with HIV and HIV/AIDS. Due to its narrow window of effective concentrations, between 1 and 4 μg/mL, and neurological side effects at supratherapeutic levels, several investigations into the pharmacokinetics of the drug and its genetic underpinnings have been carried out, primarily with adult samples. A number of studies, however, have examined the genetic influences on the metabolism of EFV in children. Their primary goal has been to shed light on issues of appropriate pediatric dosing, as well as the manifestation of neurotoxic effects of EFV in some children. Although EFV is currently being phased out of use for the treatment of both adults and children, we share this line of research to highlight an important aspect of medical treatment that is relevant to understanding the development of children diagnosed with HIV.
doi: 10.1002/cad.20344pmid: 32618382
Despite significant gains in the past 10 years in the treatment and care of children and adolescents with HIV infection, there is still need for advocacy for this group. The author discusses how far we have come and the need for on‐going efforts, not only for appropriate child‐friendly drug formulations, but also for cooperation between quantitative and qualitative scientists to further the existing knowledge base of how best to help these children with a chronic disease.
doi: 10.1002/cad.20358pmid: 32829533
Human immunodeficiency virus (HIV) has, over the last four decades, infected millions of young women and their children. Interventions developed in parallel with the spread of the virus have been able to reduce rates of vertical transmission from mother to child. The impact of HIV in children can be direct in children living with HIV (CLHIV) and exposed to HIV and uninfected, or indirect through impacts on their parents, caregivers, and family. In 2018, the United Nations joint programme on AIDS (UNAIDS) estimated that 1.7 million children were living with HIV, 160,000 were newly infected with HIV, and 100,000 died from HIV. Improvement in treatment regimens can improve the life chances of children, but adherence to treatment is a problem, especially for adolescents. Injectable long acting treatments, or interventions to improve service delivery and support for adolescents living with HIV may improve treatment success. In addition to failures of HIV prevention and treatment in CLHIV, there are concerns over exposure to the virus and antivirals leading to delayed child development. To improve the wellbeing of children affected by HIV, social support is necessary, but we need to find ways of enhancing the impact of interventions, perhaps through combining them.
Showing 1 to 10 of 10 Articles
Perinatal HIV infection is associated with delayed neurocognitive development, but less is known about children perinatally HIV‐exposed but uninfected (CHEU). We compared cognitive and language outcomes in 4–6‐year old CHEU versus children HIV‐unexposed and uninfected (CHUU) and children living with HIV (CLHIV). We enrolled 1,581 children (77% of the child population) in five communities in KwaZulu‐Natal, South Africa. Children completed: Grover‐Counter Scale of cognitive development, sub‐scales of the Kaufman Assessment Battery for Children, Reynell Developmental Language Scales. HIV status of children and primary caregivers was determined by repeated rapid tests or report of prior testing. We conducted a cross‐sectional multivariable linear regression on 922 dyads with complete data (257 CHEU, 627 CHUU, 38 CLHIV). On all outcome measures, CHEU and CHUU groups had comparable scores; CLHIV scored significantly lower. Emerging global progress toward the elimination of vertical HIV transmission may not only reduce mortality, but also positively impact child development.
Cumulative lifetime adversity and social support were investigated as determinants of psychosocial adjustment (esteem, distress, hopefulness, positive outlook/future aspirations, and sense of purpose) over 12 months in 6–10‐years‐old HIV‐infected, HIV‐exposed uninfected and HIV‐unexposed uninfected children from Uganda. Each determinant and psychosocial adjustment indicator was self‐reported using standardized questionnaires administered at baseline, 6, and 12 months. Linear mixed effects models were used to relate time‐varying lifetime adversity and social support to psychosocial adjustment over 12 months. Regardless of HIV status, higher adversity predicted lower esteem (coefficient b = −2.98, 95% confidence interval (CI): [−4.62, −1.35]) and increased distress (b =3.96, 95% CI: [1.29, 6.62]) but was not associated with hopefulness, positive outlook or sense of purpose. Low social support predicted higher distress (b =9.05, 95% CI: [7.36, 10.73]), lower positive outlook (b = −10.56, 95% CI: [−2.34, −8.79]) and low sense of purpose (b = −9.90, 95% CI: [−11.44, −8.36]) over 12 months. Pragmatic interventions that enhance coping with adversity and provide emotional/instrumental support should be tested for effectiveness in promoting resilient psychosocial adjustment trajectory in vulnerable children.