Enhancing Ugandan HIV-Affected Child Development With Caregiver Training
Condition: HIV
Study type: Interventional

Summary: 
      Early childhood (up to age 5 yrs) is a period of dramatic change in the cognitive, emotional,
      social, and behavioral domains; children continuously progress by observing and interacting
      with the world around them. In the face of economic instability and nutritional, medical and
      educational deprivation, HIV-affected very young children are the most vulnerable HIV
      subgroup globally because their families are often the most vulnerable, with little margin
      for sustaining a favorable developmental milieu for the child. Through strategic caregiver
      interventions during this sensitive period of child neurodevelopment, our study findings have
      the potential for positively re-directing the developmental trajectories of tens of millions
      of HIV-affected children globally.
    

Detailed description: 
      Background. Children up to the age of 5 years affected by HIV are the most vulnerable
      subgroup of HIV populations globally, especially in low-resource areas. This is because of
      the strategic, volatile, and vulnerable nature of this highly sensitive period of child
      development. Mediational intervention for sensitizing caregivers (MISC) has a structured
      training program to enable caregivers to improve their children's cognitive and social
      development during everyday casual interactions in the home. In our preliminary National
      Institute of Mental Health (NIMH) R34 findings, Ugandan HIV children of caregivers receiving
      MISC training biweekly for a year showed significantly greater gains on the Mullen Early
      Learning Scales Composite of g fluid intelligence, when compared to children whose caregivers
      received a standard health/nutrition education intervention (treatment as usual or TAU). The
      MISC caregivers were also significantly less depressed, and their child mortality that year
      was significantly lower. Intervention Method. The plan was to recruit approximately 100
      Ugandan HIV-positive preschool and 200 HIV orphan caregiver/child dyads will be enlisted from
      Tororo District. These dyads will be randomly assigned by village clusters to either biweekly
      MISC or health/nutrition education TAU intervention for one year. Child Outcomes are the
      child development gains on the Mullen, the Early Childhood Vigilance Test (ECVT) of
      attention, and the Color-Object Association Test (COAT) of memory, the Behavior Rating
      Inventory of Executive Functioning - Preschool (BRIEF-P), and the caregiver administered
      version of the Achenbach Child Behavior Checklist (CBCL). Caregiver Outcomes include an array
      of emotional wellbeing (EWB) and daily functioning measures validated during the initial
      qualitative study phase. Study Aim 1 will evaluate if MISC significantly enhances child
      outcomes when compared to controls for both HIV-positive and orphan children when assessed
      from baseline to 6, 12 and 24 months. Study Aim 2 will evaluate if MISC significantly
      enhances caregiver EWB and daily functioning outcomes. To better understand the mechanisms of
      MISC-enhanced child development, a Secondary Aim is to evaluate the mediating effect of
      improved caregiver EWB outcomes on corresponding child development gains, and the modifying
      effects of caregiver HIV illness and functioning on child outcomes. The Overall Impact comes
      from establishing the feasibility, acceptability, and effectiveness of MISC for HIV orphans
      and vulnerable children (OVC) and their caregivers in low resource settings; the
      sustainability of MISC in low resource settings since it is not dependent on published
      materials or outside resources; the complementary dual impact of significant
      psychotherapeutic benefit for the caregiver, especially mothers struggling with HIV disease.
      MISC will also reduce HIV child mortality because in our initial R34 findings, MISC
      heightened maternal bonding, sensitivity to serious illness, and the prompter seeking of
      medical care. It also can improve treatment adherence.
    

Intervention name(s): MISC; UCOBAC
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The Mediational Interventions for Sensitizing Caregivers; This nutrition/healthcare curriculum for children in poverty and affected by HIV was developed by a non-governmental organization (NGO) operating in Uganda called Uganda Community Based Association for Child Welfare (UCOBAC) with support from UNICEF.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: HIV affected; Child Neurodevelopment; Low and Middle Income Country