Factors Associated with HIV/AIDS Diagnostic Disclosure to HIV Infected Children Receiving HAART: A Multi-Center Study in Addis Ababa, Ethiopia

BACKGROUND: Diagnostic disclosure of HIV/AIDS to a child is becoming an increasingly common issue in clinical practice. Nevertheless, some parents and health care professionals are reluctant to inform children about their HIV infection status. The objective of this study was to identify the proportion of children who have knowledge of their serostatus and factors associated with disclosure in HIV-infected children receiving HAART in Addis Ababa, Ethiopia. METHODS: A cross-sectional study was conducted in five hospitals in Addis Ababa from February 18, 2008-April 28, 2008. The study populations were parents/caretakers and children living with HIV/AIDS who were receiving Highly Active Antiretroviral Therapy (HAART) in selected hospitals in Addis Ababa. Univariate and multivariate logistic regression analysis were carried out using SPSS 12.0.1 statistical software. RESULTS: A total of 390 children/caretaker pairs were included in the study. Two hundred forty three children (62.3%) were between 6-9 years of age. HIV/AIDS status was known by 68 (17.4%) children, 93 (29%) caretakers reported knowing the child's serostatus two years prior to our survey, 180 (46.2%) respondents said that the child should be told about his/her HIV/AIDS status when he/she is older than 14 years of age. Children less than 9 years of age and those living with educated caregivers are less likely to know their results than their counterparts. Children referred from hospital's in-patient ward before attending the HIV clinic and private clinic were more likely to know their results than those from community clinic. CONCLUSION: The proportion of disclosure of HIV/AIDS diagnosis to HIV-infected children is low. Strengthening referral linkage and health education tailored to educated caregivers are recommended to increase the rate of disclosure

Malaria illness mediated by anaemia lessens cognitive development in younger Ugandan children

BACKGROUND: Asymptomatic falciparum malaria is associated with poorer cognitive performance in African schoolchildren and intermittent preventive treatment of malaria improves cognitive outcomes. However, the developmental benefits of chemoprevention in early childhood are unknown. Early child development was evaluated as a major outcome in an open-label, randomized, clinical trial of anti-malarial chemoprevention in an area of intense, year-round transmission in Uganda. METHODS: Infants were randomized to one of four treatment arms: no chemoprevention, daily trimethoprim–sulfamethoxazole, monthly sulfadoxine–pyrimethamine, or monthly dihydroartemisinin–piperaquine (DP), to be given between enrollment (4–6 mos) and 24 months of age. Number of malaria episodes, anaemia (Hb < 10) and neurodevelopment [Mullen Scales of Early Learning (MSEL)] were assessed at 2 years (N = 469) and at 3 years of age (N = 453); at enrollment 70 % were HIV-unexposed uninfected (HUU) and 30 % were HIV-exposed uninfected (HEU). RESULTS: DP was highly protective against malaria and anaemia, although trial arm was not associated with MSEL outcomes. Across all treatment arms, episodes of malarial illness were negatively predictive of MSEL cognitive performance both at 2 and 3 years of age (P = 0.02). This relationship was mediated by episodes of anaemia. This regression model was stronger for the HEU than for the HUU cohort. Compared to HUU, HEU was significantly poorer on MSEL receptive language development irrespective of malaria and anaemia (P = 0.01). CONCLUSIONS: Malaria with anaemia and HIV exposure are significant risk factors for poor early childhood neurodevelopment in malaria-endemic areas in rural Africa. Because of this, comprehensive and cost/effective intervention is needed for malaria prevention in very young children in these settings

Evaluating Immunopathogenic Biomarkers During Severe Malaria Illness as Modifiers of the Neuropsychologic Benefits of Computer Cognitive Games Rehabilitation in Ugandan Children

Background. We explored three immunopathogenic biomarkers collected during acute malaria illness as potential moderators of gains from a computerized cognitive rehabilitation training (CCRT) intervention. Method. Von Willebrand Factor (vWF), tumor necrosis factor (TNF), and Regulated on Activation, Normal T Expressed and Secreted (RANTES) were assayed from plasma and cerebral spinal fluid (CSF) of children during acute severe malaria anemia or cerebral malaria. Two years after acute malaria illness, 150 surviving children and 150 non-malaria community controls (CC) from their households 6 to 12 years old entered a three-arm randomized controlled trial of titrating and non-titrating CCRT against no CCRT. Tests of cognition (Kaufman Assessment Battery for Children; KABC), Tests of Variables of Attention (TOVA), and Achenbach Child Behavior Checklist (CBCL) were administered before and after 24 CCRT sessions over a 3-month period, and at one-year follow-up. Differences in outcomes by trial arms and biomarker levels were evaluated using linear mixed effects models. Results. Severe malaria survivors with lower levels of vWF, lower CSF levels of TNF, and higher levels of plasma and CSF RANTES had better KABC cognitive performance after both titrating and non-titrating CCRT compared to no CCRT. For the CBCL, high plasma RANTES was associated with no benefit from either the titrating and non-titrating CCRT, while high TNF plasma was predictive of the benefit for both interventions. These biomarker moderating effects were not evident for CC children. Conclusion. Severe malaria immunopathogenic biomarkers may be related to poorer long-term brain/behavior function as evidenced by diminished benefit from a computerized cognitive rehabilitation intervention

Neruodevelopmental Outcomes in Pre-School Children Living with HIV-1 Subtypes A and D in Uganda

Background HIV is a neuropathogenic virus that may result in detrimental neurodevelopmental (ND) outcomes early in life. This is the first study to evaluate the effect of HIV-1 subtype on neurodevelopment of Ugandan pre-school children. Methods Neurodevelopment of 87 HIV-1 infected and 221 HIV exposed uninfected (HEU) Ugandan children aged 1.8 to 4.9 years was assessed using four scales of the Mullen Scales of Early Learning (MSEL), two scales of the Color Object Association Test (COAT), and one score of the Early Childhood Vigilance Test (ECVT). HIV-1 subtype was defined by phylogenetic analyses. General linear models were used to relate test scores to HIV-1 subtype (A versus D) while adjusting for relevant covariates. The scores were benchmarked against HEU group to facilitate the interpretation. Results Seventy-one percent of children infected with subtype A vs. 60% of children with subtype D were currently on antiretroviral therapy (ART) (p=0.49). Children with HIV-1 subtype A infection were older when compared to subtype D (3.29 vs. 2.76 years, respectively, p=0.03), but similar regarding sex, socioeconomic status, weight-for-age z-score, CD4+ and CD8+ (% and total), viral load. No statistically significant differences by HIV-1 subtype were observed in the MSEL, COAT, and ECVT. Differences ≥0.33 of the standard deviation were observed for the MSEL Composite Score, Receptive Language (MSEL), and Total Memory (COAT). Conclusions In contrast to previously reported differences in ND outcomes of school-aged children by HIV-1 subtype, ND scores among pre-school children were similar for subtypes A and D, with few potential differences on language production and memory outcomes that favored subtype A. Further investigation with larger sample sizes and longitudinal follow-up is needed

Patterns of disclosure characteristics of caregivers and children in Addis Ababa, Ethiopia [N = 390], April 2008.

@<p>Teacher/school, Cousins, Neighbors and Grandfather.</p><p>*Total does not add up to 390 caregivers given that 68 were already aware of their HIV status. Some percentages don't add to 100% due to rounding.</p

Disclosure status of children on HAART in Addis Ababa, Ethiopia in 2008, by demographic and social characteristics.

1<p> <i>Catholic, Protestant and Muslim.</i></p>2<p> <i>by himself/herself, Sister, Brother, Father, Both (mother/father) and Foster parents.</i></p>3<p> <i>Father, Local NGO, Uncle, Relatives and Family, Exchange rate 1 USD = 9.6 Ethiopian Birr (ETB).</i></p

Final Logistic Regression Model for Predictors of Disclosure of HIV/AIDS diagnosis to HIV-infected children in Addis Ababa, Ethiopia, April, 2008.

<p>*-Non Governmental Organization.</p><p>**OR = Odds Ratio.</p

Neruodevelopmental outcomes in pre-school children living with HIV-1 subtypes A and D in Uganda

Background: HIV is a neuropathogenic virus that may result in detrimental neurodevelopmental (ND) outcomes early in life. This is the first study to evaluate the effect of HIV-1 subtype on neurodevelopment of Ugandan preschool children. Methods: Neurodevelopment of 87 HIV-1 infected and 221 HIV exposed uninfected Ugandan children 1.8–4.9 years of age was assessed using 4 scales of the Mullen Scales of Early Learning (MSEL), 2 scales of the Color Object Association Test (COAT), and 1 score of the Early Childhood Vigilance Test. HIV-1 subtype was defined by phylogenetic analyses. General linear models were used to relate test scores to HIV-1 subtype (A versus D) while adjusting for relevant covariates. The scores were benchmarked against HIV exposed uninfected group to facilitate the interpretation. Results: Seventy-one percentage of children infected with subtype A versus 60% of children with subtype D were currently on antiretroviral therapy (P = 0.49). Children with HIV-1 subtype A infection were older when compared with subtype D (3.29 vs. 2.76 years, respectively, P = 0.03), but similar regarding sex, socioeconomic status, weight-for-age z-score, CD4+ and CD8+ (% and total), viral load. No statistically significant differences by HIV-1 subtype were observed in the MSEL, COAT and Early Childhood Vigilance Test. Differences ≥ 0.33 of the SD were observed for the MSEL Composite Score, Receptive Language (MSEL) and Total Memory (COAT). Conclusions: In contrast to previously reported differences in ND outcomes of school-age children by HIV-1 subtype, ND scores among preschool children were similar for subtypes A and D, with few potential differences on language production and memory outcomes that favored subtype A. Further investigation with larger sample sizes and longitudinal follow-up is neede