Early Childhood Development Caregiver Training and Neurocognition of HIV-Exposed Ugandan Siblings.

The siblings were secondary participants from households assigned to caregiver training, not independently randomised children, so this was a supplemental cluster trial analysis. Both arms were active caregiver programs; there was no true control, so the study cannot show whether caregiver training helps siblings at all, only whether MISC added benefit over UCOBAC. Several cognitive outcomes were tested, and the early significant KABC differences were not significant after Bonferroni adjustment. Of 294 enrolled siblings, 216 were analysed and only 181 had all 3 repeated measures, so the analysed sample is smaller than the enrolled sample. Only households in which the caregiver completed all 24 training sessions were included, so the results may not apply to families who do not complete the full program. The study did not measure whether caregivers used MISC skills with the older siblings. The main MISC trial had limited strong findings for the target preschool children, so collateral sibling effects are less certain.

The authors declare no conflict of interest; the article is listed as supported by NIH extramural research.

Do not attribute sibling outcomes to MISC training alone. All children received a nutritional supplement, both arms included caregiver training, and the early cognitive gains did not survive correction for multiple outcomes, so the effect of any single MISC component cannot be isolated.