The Association of Home Environment and Caregiver Factors With Neurocognitive Function in Pre-school- and School-Aged Perinatally Acquired HIV-Positive Children on cART in South Africa.

Antonio G Lentoor

doi:10.3389/fped.2019.00077

Abstract

Background: Children with perinatally acquired HIV in low resource settings are at risk for neurocognitive impairments not only due to the direct effects of HIV on the brain and in utero ART exposure but also due to factors associated with their environment. Thus, the aim of this study was to examine the association between home environment and caregiver factors and the neurocognitive function of pre-school- and-school-aged HIV-positive South African children from low resource rural communities.Materials and Methods: The Wechsler Preschool and Primary Scale of Intelligence-III was administered to assess the neurocognitive functioning of 152 purposively sampled perinatally acquired HIV-positive children on cART, aged 3 years to 7 years 6 months (mean age 63.13 months). The primary caregivers (n = 152) completed the Home Screening Questionnaire to assess the quality of the home-environment of the children.Results :The results showed that unfavorable environment, caregiver type, and quality of stimulation in the home were negatively associated with the neurocognitive development of perinatally HIV-positive children on cART. Most of the HIV-positive children (n = 95) were under the care of an extended relative. Older HIV-positive boys, reared by biological mothers, who also lived in suboptimal and poor quality home-environments had poorer neurocognitive function when compared to HIV-positive children reared by non-biological (extended relatives) caregivers, [F(2,149) = 14.42, p < 0.001].Conclusion: The child's early home environment is associated with general neurocognitive development, which highlights the need for early psychosocial interventions that can promote better cognitive outcomes among children living with HIV.

Highlights

With the global availability of combination antiretroviral therapy to perinatally acquired HIV-positive children, we witnessed a decline in premature death, and more children living with HIV have a greater chance of growing into school-age, adolescence, and even adulthood [1, 2]
The results indicate that all of the children in the study lived in unfavorable home environments (n = 152, 100%) based on the Home Screening Questionnaire (HSQ) scores (14.69 ± 3.22)
The results interestingly suggest that the amount of stimulation a child is exposed to in the home environment, as measured on the HSQ, significantly influences the sub-neurocognitive domain of verbal neurocognitive functioning (VIQ) as indicated in their negative association (r = −0.18, p < 0.05)

Summary

Introduction

With the global availability of combination antiretroviral therapy (cARTs) to perinatally acquired HIV-positive children, we witnessed a decline in premature death, and more children living with HIV have a greater chance of growing into school-age, adolescence, and even adulthood [1, 2]. A systematic review of published work in Africa showed that neurodevelopmental delays in perinatally HIV-positive children were related to socioenvironmental risk factors and not entirely due to the HIV infection [8]. Psychosocial factors such as suboptimal home environment [9], inadequate social support, caregiver unemployment [10] and maternal depression [11] are all factors that have been shown to influence neurocognitive function of children in addition to HIV. The aim of this study was to examine the association between home environment and caregiver factors and the neurocognitive function of pre-school- and-school-aged HIV-positive South African children from low resource rural communities

Objectives

Methods

Results

Conclusion