Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe.

Journal: BMJ global health

Volume: 4

Issue: 5

Year of Publication: 

Affiliated Institutions:  Institute of Global Health, University College London, London, UK. MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK. Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe. MRC Tropical Epidemiology Group, World Education Inc./Bantwana, Harare, Zimbabwe.

Abstract summary 

HIV-exposed children show signs of developmental delay. We assessed the impact of a pragmatic multicomponent intervention for caregivers of HIV-exposed children aged 0-2 years in Zimbabwe.We conducted a cluster-randomised trial from 2016 to 2018. Clusters were catchments surrounding clinics, allocated (1:1) to either National HIV guidelines standard of care or standard care plus an 18-session group intervention comprising i) early childhood stimulation (ECS) and parenting training with home visits to reinforce skills and retention in HIV care; ii) economic strengthening. Primary outcomes measured 12 months after baseline (4.5 months postintervention completion) included: i) global child development measured using the Mullen early learning composite score; ii) retention in HIV care. Analysis used mixed effects regression to account for clustering and adjusted minimally for baseline prognostic factors and was by intention to treat.Thirty clusters, 15 in each arm, were randomised. 574 dyads were recruited with 89.5% retained at follow-up. Ninety one of 281 (32.4%) were recorded as having received the complete intervention package, with 161/281 (57.3%) attending ≥14 ECS sessions. There was no evidence of an intervention effect on global child development (intervention mean 88.1 vs standard of care mean 87.6; adjusted mean difference=0.06; 95% CI -2.68 to 2.80; p=0.97) or infant retention in care (proportion of children who had missed their most recent HIV test: intervention 21.8% vs standard of care 16.9%, p=0.18). There was weak evidence that the proportion of caregivers with parental stress was reduced in the intervention arm (adjusted OR (aOR)=0.69; 95% CI 0.45 to 1.05; p=0.08) and stronger evidence that parental distress specifically was reduced (intervention arm 17.4% vs standard of care 29.1% scoring above the cut-off; aOR=0.56; 95% CI 0.35 to 0.89; p=0.01).This multicomponent intervention had no impact on child development outcomes within 4.5 months of completion, but had an impact on parental distress. Maternal mental health remains a high priority.PACTR201701001387209.

Authors & Co-authors:  Mebrahtu Helen H Simms Victoria V Mupambireyi Zivai Z Rehman Andrea M AM Chingono Rudo R Matsikire Edward E Malaba Rickie R Weiss Helen A HA Ndlovu Patience P Cowan Frances M FM Sherr Lorraine L

Study Outcome 

Source Link: Visit source

Statistics
Citations :  Yousafzai A, Bhutta Z. Integrating early child development interventions in child health services: opportunities and challenges in developing countries : Kamat D, American Academy of pediatrics textbook of global child health. 1st edn Washington DC: American Academy of Pediatrics, 2012.
Authors :  11
Identifiers
Doi : e001651
SSN : 2059-7908
Study Population
Male,Female
Mesh Terms
Other Terms
Early childhood development;HIV-exposed infants;Internal savings and lending scheme;RCT;Zimbabwe
Study Design
Study Approach
,Mixed Methods
Country of Study
Zimbabwe
Publication Country
England