Cognitive and physical development in HIV-positive children in South Africa and Malawi: A community-based follow-up comparison study.
L Sherr, I S Hensels, M Tomlinson and 2 others
PMID 29047149WHAT IT FOUND
HIV-positive children in South Africa and Malawi showed lower growth, school, physical, cognitive and quality-of-life scores than HIV-negative children.
Their improvement over follow-up was mostly similar, except physical functioning improved more.
Key findings
01At baseline, HIV-positive children were more often stunted (58.8% versus 27.4%) and underweight (18.7% versus 7.1%), and had lower physical functioning (M=93.37, SD=13.37 versus M=97.00, SD=9.78), digit span (M=7.19, SD=3.87 versus M=9.03, SD=3.92) and draw-a-person (M=79.18, SD=21.39 versus M=87.08, SD=17.91) scores.
02After adjustment for country, caregiver gender, caregiver HIV status, household HIV, family sickness, food insecurity and caring for younger children, HIV-positive children were more than three times as likely to be stunted (OR, 3.25; CI, 2.05-5.15), while adjusted differences on digit span (B=-0.64, p=.092) and draw-a-person (B=-2.23, p=.23) were not significant.
03At follow-up, HIV-positive children were still more often stunted and underweight and had lower digit span, draw-a-person, educational functioning and quality-of-life scores; physical functioning was the outcome with a significant between-group difference in change over time (F(1, 729)=4.03, p=.045).
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
HIV status was based on caregiver report and not biologically confirmed, so some HIV-positive children may have been missed. HIV treatment was measured only at follow-up, so change over time in treatment could not be assessed. The sample likely included HIV-exposed but uninfected children, whose developmental trajectory is not well known. The cognitive tests were screening tools, not a gold-standard IQ measure, and many tools were not validated directly in South Africa or Malawi. Follow-up was incomplete, and children lost to follow-up differed from those retained, including younger parents, more South African residence, more informal housing, more non-attendance at school, and more food security. The study compares groups and does not test therapy, so it cannot show that any service caused the differences or improvements.
Declared interests
Eleven funding partners participated in the study: World Vision, Comic Relief, Save the Children, Firelight Foundation, Help Age, UNICEF, REPSSI, Bernard van Leer Foundation, STOP AIDS Now, AIDS Alliance and the Diana Memorial Fund. They provided access to funded community-based organisation programmes.
The easy way to misread this
Do not read the lower cognitive and physical scores as proof that HIV alone caused them, or the follow-up improvement as proof that treatment worked. HIV status was caregiver-reported, not biologically confirmed, and children received varied community services.