Effect of Caregiver Training on the Neurodevelopment of HIV-Exposed Uninfected Children and Caregiver Mental Health: A Ugandan Cluster-Randomized Controlled Trial.

There was no true control group, so the trial cannot show whether either caregiver training was better than no caregiver training or usual community support. All children received the same nutritional supplement, so any shared developmental benefit cannot be separated from the training content. The primary cognitive outcome was null, while some secondary findings favoured UCOBAC for child executive function and caregiver depression, so the pattern is mixed and should not be read as evidence that MISC works. The child cognitive measures were standardized in high-income settings, making absolute scores hard to interpret for this rural Ugandan cohort. Follow-up was only 12 months after training ended, so longer-term effects on development and caregiver mental health are unknown. Some baseline imbalances existed, including worse BRIEF scores for MISC children and greater functional impairment for UCOBAC caregivers, although analyses adjusted for baseline. The main analysis excluded 17 dyads from 221 enrolled, and attrition was still high by 24 months, though similar across arms.

The authors declared no conflicts of interest or financial interests.

Do not conclude that cognitive-stimulation caregiver training improves child development. The primary MSEL outcome showed no difference, receptive language gains were not significant (p=0.10) and were not sustained, and MISC children had worse reported executive function behaviours. Both arms also received the same nutritional supplement, so nutrition effects cannot be attributed to either training.