Year: 2008
Type: dissertation
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: ABSTRACT \nPaediatric HIV remains one of the most significant challenges to face children, their \nfamilies and their health care providers in South Africa. The prevalence rate of paediatric \nHIV infection in South Africa is set to remain high until such time as universal access to \nantiretrovirals for prevention of mother to child transmission is achieved, and the mother \nto child transmission rates of HIV start to come down. \nHIV is neurotrophic and is known to invade the developing central nervous system and \ncause widespread damage. The result of this is a well described encephalopathy which \nhas the potential to affect all facets of development. \nChildren in South Africa who are infected with HIV are vulnerable to a number of factors \nwhich may cause developmental delay. Poverty and malnutrition are likely to exacerbate \nthe developmental delay caused by HIV encephalopathy. Physiotherapists in South \nAfrica have not become involved in the long term management of children infected with \nHIV and paediatric HIV clinics do not routinely offer any rehabilitation services. \nThe prevalence and extent of developmental delay in HIV infected children in South \nAfrica has not been established. Despite the fact that a number of studies have \nhighlighted the prevalence of developmental delay in Western countries, no intervention \nstudies addressing this problem could be found. \nCaregivers of HIV infected children face numerous stressors. Poverty, stigma and their \nown health care needs make parenting an HIV positive child even more challenging. \nThe needs of caregivers of HIV infected children have not been well researched in the \ncontext of developing countries. \nThe aim of this study was therefore to establish whether a basic home stimulation \nprogramme would have any impact on the neurodevelopmental status of young children \ninfected with HIV, and on the parenting stress levels of their caregivers. Further objectives of the study were to establish the prevalence and progression of \ndevelopmental delay in HIV infected children; to monitor the effect of antiretrovirals on \nneurodevelopment; to determine who the caregivers of HIV infected children were and \nto determine what factors were predictive of neurodevelopmental status and parenting \nstress levels. \nIn order to meet these objectives a longitudinal randomized controlled trial was \nconducted. One hundred and twenty two HIV positive children, under two and a half \nyears of age, were recruited for this study at Harriet Shezi Children’s Clinic at Chris Hani \nBaragwanath Hospital in Soweto. \nChildren were randomly assigned to a control or an experimental group. The \ndevelopmental status of all children was monitored over a year using the Bayley Scales \nof Infant Development II. Parenting stress was monitored with the Parenting Stress \nIndex/Short Form. Children in the experimental group received a basic home stimulation \nprogramme, which was updated every three months when they came to visit the clinic, \nas well as all the usual clinic services. Children in the control group received all the \nusual services at the clinic but no stimulation programme. \nMost of the children in the sample were cared for by their biological mothers. They came \nfrom poor homes with limited access to common household amenities. Most of the \ncaregivers had not completed 12 years of schooling. \nThe children in the control and experimental groups were well matched for all their \nbaseline measurements and demographic characteristics. At baseline the children were \nwasted and stunted and had very low CD4 counts. Only 16% of the children were on \nantiretrovirals at baseline assessment. The children were severely delayed with respect \nto both motor and cognitive development. The parenting stress levels of the caregivers \nwere very high at baseline. \nOver the period of one year the children in the experimental group showed a \nsignificantly greater improvement in cognitive (p=0.01) and motor (p=0.02) development when compared to children in the control group. Although the children improved, they \nstill had a degree of developmental delay at the end of the study period. \nThe parenting stress levels decreased significantly for caregivers in both the control and \nthe experimental groups (p<0,001), but there was no significant difference between the \ntwo groups (p=0.057). \nThe groups were well matched at all time points for anthropometric measures and CD4 \ncounts with no significant differences being found. There was also no difference in the \nnumber of children on antiretroviral therapy between the groups at any time. \nChildren who were antiretroviral naïve at the start of the study and then started highly \nactive antiretroviral therapy showed a significant improvement in motor development \n(p<0.001), but no improvement in cognitive development (p=0.77). \nA combination of a number of factors was predictive of developmental status. This included growth parameters, CD4 counts and the age of the child. Being in the \nexperimental group and being older at baseline assessment were important predictors of \nimprovement in MDI and PDI over time. Parenting stress was predicted by a number of \nfactors, including educational level of the caregiver, type of housing and the number of \nchildren in the household. A decrease in parenting stress was most likely in caregivers \nwho were better educated and who lived in households with fewer adults. \nThese results signify that a basic home programme can significantly improve both the \ncognitive and motor development of young children infected with HIV. This programme \nwas simple and easily implemented and should become standard practice at paediatric \nHIV clinics in South Africa. The current protocol for administering antiretrovirals in South \nAfrica allowed for motor, but not cognitive improvement in young children commencing \ntreatment. Parenting stress was not affected by the addition of a basic home stimulation \nprogramme.The psychosocial and developmental needs of South African children infected with HIV \nare complex and multifaceted. Further research is needed to establish the best possible \ninterventions for these children and their families.
Author: Joanne Potterton
Language: English
Topic: HIV Research and Treatment
Subfield: Virology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W2274152181