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Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe.
Mebrahtu, Helen; Simms, Victoria; Mupambireyi, Zivai; Rehman, Andrea M; Chingono, Rudo; Matsikire, Edward; Malaba, Rickie; Weiss, Helen A; Ndlovu, Patience; Cowan, Frances M; Sherr, Lorraine.
Affiliation
  • Mebrahtu H; Institute of Global Health, University College London, London, UK.
  • Simms V; MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
  • Mupambireyi Z; Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.
  • Rehman AM; MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
  • Chingono R; Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.
  • Matsikire E; Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.
  • Malaba R; MRC Tropical Epidemiology Group, World Education Inc./Bantwana, Harare, Zimbabwe.
  • Weiss HA; MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
  • Ndlovu P; MRC Tropical Epidemiology Group, World Education Inc./Bantwana, Harare, Zimbabwe.
  • Cowan FM; Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.
  • Sherr L; International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
BMJ Glob Health ; 4(5): e001651, 2019.
Article de En | MEDLINE | ID: mdl-31565411
ABSTRACT

INTRODUCTION:

HIV-exposed children show signs of developmental delay. We assessed the impact of a pragmatic multicomponent intervention for caregivers of HIV-exposed children aged 0-2 years in Zimbabwe.

METHODS:

We conducted a cluster-randomised trial from 2016 to 2018. Clusters were catchments surrounding clinics, allocated (11) to either National HIV guidelines standard of care or standard care plus an 18-session group intervention comprising i) early childhood stimulation (ECS) and parenting training with home visits to reinforce skills and retention in HIV care; ii) economic strengthening. Primary outcomes measured 12 months after baseline (4.5 months postintervention completion) included i) global child development measured using the Mullen early learning composite score; ii) retention in HIV care. Analysis used mixed effects regression to account for clustering and adjusted minimally for baseline prognostic factors and was by intention to treat.

RESULTS:

Thirty clusters, 15 in each arm, were randomised. 574 dyads were recruited with 89.5% retained at follow-up. Ninety one of 281 (32.4%) were recorded as having received the complete intervention package, with 161/281 (57.3%) attending ≥14 ECS sessions. There was no evidence of an intervention effect on global child development (intervention mean 88.1 vs standard of care mean 87.6; adjusted mean difference=0.06; 95% CI -2.68 to 2.80; p=0.97) or infant retention in care (proportion of children who had missed their most recent HIV test intervention 21.8% vs standard of care 16.9%, p=0.18). There was weak evidence that the proportion of caregivers with parental stress was reduced in the intervention arm (adjusted OR (aOR)=0.69; 95% CI 0.45 to 1.05; p=0.08) and stronger evidence that parental distress specifically was reduced (intervention arm 17.4% vs standard of care 29.1% scoring above the cut-off; aOR=0.56; 95% CI 0.35 to 0.89; p=0.01).

CONCLUSION:

This multicomponent intervention had no impact on child development outcomes within 4.5 months of completion, but had an impact on parental distress. Maternal mental health remains a high priority. TRIAL REGISTRATION NUMBER PACTR201701001387209.
Mots clés

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Type d'étude: Clinical_trials / Guideline / Health_economic_evaluation / Prognostic_studies Langue: En Journal: BMJ Glob Health Année: 2019 Type de document: Article Pays d'affiliation: Royaume-Uni

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Type d'étude: Clinical_trials / Guideline / Health_economic_evaluation / Prognostic_studies Langue: En Journal: BMJ Glob Health Année: 2019 Type de document: Article Pays d'affiliation: Royaume-Uni