Lisa Langhaug (Zimbabwe)
Zvitambo Institute for Maternal and Child Health Research ResearchAuthor Of 1 Presentation
THE EFFECT OF HIV-EXPOSURE ON SCHOOL-AGE HEALTH OUTCOMES IN RURAL ZIMBABWE
Abstract
Backgrounds:
It is unclear whether there are persistent school-age health, growth and developmental disparities between children who are HIV-exposed but uninfected (CHEU) versus HIV-unexposed (CHU). Long-term follow up of a cohort of children recruited to the SHINE trial, who are now aged 7-8 years, offers the opportunity to compare school-age outcomes in a setting where 15% of children are HIV-exposed.
Methods
We measured physical function using handgrip strength, broad jump and the shuttle run test to provide a standardized score. Cognitive function was evaluated using the Kaufman Assessment Battery for Children (KABC-II), with additional tools measuring executive function, literacy, numeracy, fine motor skills and socioemotional function. Growth was assessed by anthropometry, body composition (using bioimpedance analysis) and skinfold thicknesses. A detailed caregiver questionnaire measured demographics, socioeconomic status, nurturing, child discipline, food and water insecurity. Results for CHEU and CHU were compared using generalized estimating equations with an exchangeable working correlation structure to account for clustering.
Results:
328 rural Zimbabwean children (89 CHEU, 239 CHU) were assessed at age 7-8 years. CHEU were 2 months older than CHU (95%CI, 1mo to 3mo, p<0.001), and had marginally reduced height-for-age Z-score, HAZ (-0.22, 95% CI -1.89, 0.01 p=0.06). CHEU had significantly reduced total KABC-II scores (-4.6 marks, 95%CI -6.8, -2.3; p<0.001) and weak evidence for reduced literacy and numeracy scores (-5 marks, 95%CI -11, 1; p=0.10). CHEU had slightly higher socioemotional issues as measured by the strength and difficulties questionnaire (1.4 marks, 95% CI -0.04, 2.86, p=0.06).
Conclusions/Learning Points:
Our results indicate that antenatal HIV exposure has a persistent effect on CHEU growth and neurodevelopment at age 7 years, particularly for cognitive function.