The burden and predictors of cognitive impairment among 6- to 8-year-old children infected and uninfected with HIV from Harare, Zimbabwe: a cross-sectional study.

With long-term survival of children infected with HIV, information on cognitive function at school age is needed. To determine cognitive function among 6- to 8 year-old children exposed to HIV and to assess factors associated with cognitive impairment, we conducted a cross-sectional study from October 2010 to December 2011 among children whose mothers participated in a national HIV prevention program in Harare. Cognitive function was assessed using the McCarthy Scales of Children's Abilities (MSCA). Of the 306 assessed children, 32 (10%) were HIV infected, 121 (40%) exposed uninfected, and 153 (50%) unexposed uninfected. The mean (SD) General Cognitive Index for the whole study group was 82 (15). An overall of 49 (16%) out of the 306 children had cognitive impairment with no difference in general cognitive function among the three groups. Children with HIV infection scored lowest in perceptual performance domain, p = .028. Unemployed caregivers, child orphanhood and undernutrition were associated with impaired cognitive performance in univariate analysis. In multivariate analysis, caregiver unemployment status remained a factor associated with cognitive impairment with an ODDS ratio of 2.1 (95% CI 1.03-3.36). In a cohort of 6- to 8-year-olds, HIV infection did not show evidence of significant difference in general cognitive function. Children infected with HIV had major deficits in perceptive performance. Lower socioeconomic status was associated with cognitive impairment. In resource-constrained settings, strategies aimed at poverty alleviation and good nutritional management should complement early infant diagnosis and treatment of HIV in order to optimize neurocognitive potential.

Realities and Challenges of a Five Year Follow Up of Mother and Child Pairs on a PMTCT Program in Zimbabwe.

BACKGROUND: Complete follow up is an essential component of observational cohorts irrespective of the type of disease. OBJECTIVES: To describe five years follow up of mother and child pairs on a PMTCT program, highlighting loss to follow up (LTFU) and mortality (attrition). STUDY DESIGN: A cohort of pregnant women was enrolled from the national PMTCT program at 36 weeks gestational age attending three peri urban clinics around Harare offering maternal and child health services. Mother-infant pairs were followed up from birth and twice yearly for five years. RESULTS: A total of 479 HIV infected and 571 HIV negative pregnant women were enrolled, 445(92.9%) and 495(86.6%) were followed up whereas 14(3.0%) and 3(0.5%) died in the 1st year respectively; RR (95%CI) 5.3(1.5-18.7). At five years 227(56.7%) HIV infected and 239(41.0%) HIV negative mothers turned up, whereas mortality rates were 34 and 7 per 100 person years respectively. Birth information was recorded for 401(83.7%) HIV exposed and 441(77.2%) unexposed infants, 247(51.6%) and 232(40.6) turned up in the first year whilst mortality was 58(12.9%) and 22(4.4%) respectively, RR (95%CI) 3.2(2.0-5.4). At five years 210(57.5%) HIV exposed and 239(44.3%) unexposed infants were seen, whilst mortality rates were 53 per 1000 and 15 per 1 000 person years respectively. Mortality rate for HIV infected children was 112 compared to 21 per 1 000 person years for the exposed but uninfected. CONCLUSION: HIV infected mothers and their children succumbed to mortality whereas the HIV negatives were LTFU. Mortality rates and LTFU are high within PMTCT program.