20th International AIDS Conference - Melbourne, Australia


TUAE0102 - Oral Abstract

Futures at risk - disability in children affected by HIV in South Africa and Malawi

Presented by Lorraine Sherr (United Kingdom).

S. Skeen1,2, A. Macedo3, L. Sherr4, N. Croome3, M. Tomlinson1

1Stellenbosch University, Psychology, Stellenbosch, South Africa, 2University of Cape Town, Psychiatry and Mental Health, Cape Town, South Africa, 3UCL, London, United Kingdom, 4UCL, Research Department of Infection and Population Health, London, United Kingdom

Background: HIV infection has been linked with developmental disabilities in children as a result of consequences of infection, exposure to antiretroviral medication, co-morbid illnesses, and increased lengthy hospital admissions . Other risk factors for developmental delay prevalent in HIV-affected families include living in poverty, food insecurity, parental depression and substance use. This study investigated developmental outcomes in children participating in community-based organisation (CBO) programmes for children affected by HIV in South Africa and Malawi over time.
Methods: We interviewed carers of children attending 28 randomly-selected CBOs in South Africa and Malawi. Carers completed the validated Ten Questions disability screening tool at baseline which screened for child developmental problems in domains of speech, cognition, hearing, vision, motor and seizure disorders. Communication, comprehension and learning appraisal was measured at 1 year follow up. Household HIV was tracked.
Results: Of 500 consecutive CBO attenders,(aged 4 -9) 74 were HIV+ and 426 HIV-. Overall, 217 (43.4%) showed delay, significantly higher for HIV+ children (24.4%,n=53 versus 7.4%, n=21 -p< 0.0001). More specifically, HIV+ children were at increased risk for delay in achieving motor milestones (e.g.sitting, standing, or walking) (33.8% vs 6.3%-p< 0.0001); hearing difficulties (18.8% versus 8.9%-p=0.02), speech problems (20.3% versus 10.3%,-p=0.02), and mental difficulties (e.g., slowness) (28.4% versus 13.1%-p=0.01). Multivariate analysis revealed that independent predictors of developmental disability included HIV status (OR: 4.55, 95% CI: 2.29-9.04, p< 0.0001) as well as living in South Africa (OR: 0.29, 95% CI: 0.12-0.72, p-0.006) and poor school attendance (OR: 2.94, 95% CI: 1.09-7.97), p=0.03). At follow up HIV+children continued to have more difficulties in understanding (8.5% vs. 2.7%-p=.02) and learning new things (25.4% vs. 14.3%-p=.02) compared to HIV-ve children. Difficulty in communicating did not differ by HIV status. Furthermore HIV- children living with someone with HIV in the household showed similar scores to HIV- children living in HIV-free households.
Conclusions: Rates of child developmental disabiliy are high in poor HIV affected communities. These children face challenges in accessing schooling in contexts where little specialised provision is available. We call for increased awareness of the need for inclusive and specialised educational support for children affected by HIV in communities affected by HIV.

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