The Neurodevelopment and Mental Health of Children Affected by HIV in Sub-Saharan Africa

Abstract

This dissertation assesses neurodevelopment in children affected by HIV in Botswana, by examining associations between a range of factors and neurodevelopmental outcomes at 24 months of age and adjusting for potential confounders through linear regression. We followed children from birth to approximately 24 months to assess their neurodevelopment with an adapted version of Bayley Scales of Infant Development third edition (BSIDIII: cognitive, gross motor, fine motor, expressive and receptive language domains) and with the Development Milestones Checklist (DMC: locomotor, fine motor, language and personal-social domains), a parent-completed questionnaire. Chapter I compares neurodevelopment between HIV-exposed uninfected (HEU) children whose mothers took antenatal 3-drug combination antiretroviral therapy (ART) vs. zidovudine (ZDV) within a prospective study, nested within two cohorts of HIV-infected mothers and their children in Botswana (one observational, one interventional). We observed that neurodevelopmental outcomes at 24 months of age were generally at least as good among HEU children exposed in utero to ART when compared to those exposed in utero to ZDV. Chapter II compares neurodevelopment between HEU vs. HIV-unexposed uninfected (HUU) children in Botswana, within a prospective observational study. We observed that neurodevelopmental outcomes at 24 months among HEU children were generally as good as those among unexposed children. Results from Chapter I and II provide reassurance, easing concerns that HIV or ARV-exposure may detrimentally affect neurodevelopment in young children. Chapter III examines the potential of a family-based intervention for use in reducing harmful alcohol use and intimate partner violence, to protect and promote child mental health, within families affected by HIV in Rwanda. Quantitative data from a randomized controlled trial (RCT) were analyzed to demonstrate significant reductions in alcohol-use and intimate partner violence within HIV-affected families receiving the intervention, when compared to control families. Quantitative and qualitative data from the RCT, were integrated using a mixed-method approach, and support the potential of family-based interventions to reduce adverse caregiver behaviors as a major mechanism for improving child well-being, for families affected by HIV in Sub-Saharan Africa.