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  1. The brain of a child: Understanding cognitive development for children living with HIV Prof Lorraine Sherr, University College London Member Coalition for Children Affected by AIDS

  2. Presentation AIM • Review the evidence of cognitive impact of HIV for HIV+ve and HIV exposed and Uninfected children • Explore the complexity of responding to cognitive challenges • Community Care study data the role of cash grants, and cash plus care, cash plus nutrition on cognitive outcomes • Chidotrial data to show parental factors impact on cognitive outcomes • Examine promising interventions

  3. Cognitive development HEU HIV+ve Children Cognitive delay Systematic review – 11 studies (650 HIV affected, 736 Control 205 HIV+ve) Sig lower than controls on at least 1 measure in 7/11 studies. (Sherr et al AIDS Behav 2014, Nov 18(11) 2059-74); Le Doare et al Pediatrics 2012 Nov 130(5)e 1326-44 Morbidity and Mortality effects Slogroveet al 2016 – 22 studies, 3 specifically designed. • Systematic reviews • Sherr et al 2009; Sherr et al 2015 • McHenry et al 2018 45 Studies Both HIV+ve and HEU children had worse developmental outcomes compared to HIV Uninfected Unexposed Children.

  4. HIV Affected(Filteau et al 2009, Sherr et al AIDS Behav 2014, Nov 18(11) 2059-74); Le Doare et al Pediatrics 2012 Nov 130(5)e 1326-44

  5. HIV +vechildren at risk of developmental delay – Community Care Study (Sherr et al various) (n=979) Degree of delay higher among HIV positive children. HIV status remained a strong independent predictor even after adjusting for other confounders (AOR: 4.55, 95% CI: 2.29-9.04, p<0.0001)

  6. HIV and other developmental outcomes • HIV +veworse at school • HIV +ve significantly > emotional and behavioural problems - conduct, hyperactivity-inattention, or peer problems. • HIV +ve significantly < health-related quality of life.

  7. Cash grants and Struggling in school

  8. Cash + care and Cognitive abilitySherr Macedo, Tomlinson, Skeen & Cluver BMC 2017 Draw-a-person, F(3)=52.31, p<.001. Digit span F(3)=10.67, p<.001

  9. Cash + care and difficulties in remembering (F(3)=3.99, p=.008), learning (F(3)=9.92, p<.001), and comprehension (F(3)=1.68, p>.05)

  10. CASH + NUTRITIONcontrolling for gender, age, HIV status, disability score, no household assets and school attendance

  11. COGNITIVE OUTCOMES FOR CASH + NUTRITION

  12. Zimbabwe Chido Trial (Mebrahtu, Chingono, MupambireyiNdlovu,MalabaSherr Cowan et al 2018) Caregiver depression inventory scores and infant cognition *Adjusted for infant age, HIV status, growth rate, caregiver’s employment status and examiner conducting the Mullen assessments.

  13. Caregiver stress and infant cognition *Adjusted for infant age, HIV status, growth rate, and examiner conducting the Mullen assessments.

  14. INTERVENTIONS

  15. CONCLUSION

  16. Child Community Care study • Funded by SIDA-NORAD, through HelpAge • Zambia add on funded by Unicef • Supported by Coalition for Children Affected by AIDS

  17. Prof. Lorraine Sherr Prof. Frances M. Cowan Helen Mebrahtu Dr. Victoria Simms Prof. Helen A. Weiss RudoChingono Dr. ZivaiMupambireyi Patience Ndlovu Rickie Mlaba Andrea Rehman CHIDO TRIAL