Effect of caregiver training on the neurodevelopment of HIV-exposed uninfected children and caregiver mental health: A ugandan cluster-randomized controlled trial

Michael J. Boivin; Noeline Nakasujja; Itziar Familiar-Lopez; Sarah M. Murray; Alla Sikorskii; Jorem Awadu; Cilly Shohet; Deborah Givon; Horacio Ruiseñor-Escudero; Elizabeth E. Schut; Robert O. Opoka; Judith K. Bass

doi:10.1097/DBP.0000000000000510

Effect of caregiver training on the neurodevelopment of HIV-exposed uninfected children and caregiver mental health: A ugandan cluster-randomized controlled trial

Michael J. Boivin, Noeline Nakasujja, Itziar Familiar-Lopez, Sarah M. Murray, Alla Sikorskii, Jorem Awadu, Cilly Shohet, Deborah Givon, Horacio Ruiseñor-Escudero, Elizabeth E. Schut, Robert O. Opoka, Judith K. Bass

Research output: Contribution to journal › Article › peer-review

47 Scopus citations

Abstract

Objective: Early childhood development programs typically combine healthy nutrition and cognitive stimulation in an integrated model. We separately delivered these 2 components in a cluster-randomized controlled trial to evaluate their comparative effectiveness in promoting healthy child development and caregiver mental health. This is the first study to do so for HIV-affected children and their infected mothers. Methods: Two hundred twenty-one HIV-exposed but uninfected child (2-3 years old) and caregiver dyads in 18 geographic clusters in Eastern Uganda were randomized by cluster to receive biweekly individualized sessions of either (1) Mediational Intervention for Sensitizing Caregivers (MISC) training emphasizing cognitive stimulation or (2) Uganda Community Based Association for Child Welfare (UCOBAC) program that delivered health and nutrition training. Children were evaluated at baseline, 6 months, 1 year (training conclusion), and 1-year posttraining with the Mullen Scales of Early Learning (MSEL), the Color-Object Association Test for memory, the Early Childhood Vigilance Test of attention, and the Behavior Rating Inventory of Executive Function (BRIEF-parent). The Caldwell Home Observation for the Measurement of the Environment (HOME) was completed by observers to gauge caregiving quality after training. Caregiver depression/anxiety (Hopkins Symptom Checklist-25) and functionality (list of activities of daily living) were also evaluated. Data collectors were blinded to trial arm assignment. Results: Mediational Intervention for Sensitizing Caregivers resulted in significantly better quality of caregiving compared with UCOBAC midintervention with an adjusted mean difference (M_adjDiff) of 2.34 (95% confidence interval [CI]: 1.54-3.15, p < .01), postintervention (M_adjDiff 5 2.43, 95% CI: 1.61-3.25, p < .01), and at 1-year follow-up (M_adjDiff 5 2.07, 95% CI: 1.23-2.90, p < .01). MISC caregivers reported more problems on the BRIEF for their child at 1-year posttraining only (p < .01). Caregiving quality (HOME) was significantly correlated with MSEL composite performance 1-year posttraining for both the MISC and the UCOBAC trial arms. Likewise, physical growth was significantly related to child development outcomes even though it did not differ between trial arms. Conclusion: Even though MISC demonstrated an advantage of improving caregiving quality, it did not produce better child cognitive outcomes compared with health and nutrition training. Trial Registration: clinicaltrials.gov Identifier: NCT01640561.

Original language	English
Pages (from-to)	753-764
Number of pages	12
Journal	Journal of Developmental and Behavioral Pediatrics
Volume	38
Issue number	9
DOIs	https://doi.org/10.1097/DBP.0000000000000510
State	Published - 2017
Externally published	Yes

Bibliographical note

Publisher Copyright:
Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved.

Funding

From the Departments of *Psychiatry and †Neurology & Ophthalmology, Michigan State University, East Lansing, MI; ‡Department of Psychiatry, University of Michigan, Ann Arbor, MI; §Department of Psychiatry, Makerere University, Kampala, Uganda; \Department of Statistics & Probability, Michigan State University, East Lansing, MI; ¶Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; **Department of Statistics and Probability, Michigan State University, East Lansing, MI; ††College of Education, Michigan State University, East Lansing, MI; ‡‡Child Development Program, School of Education, Bar Ilan University, Ramat-Gan, Israel; §§Department of Psychiatry, Michigan State University, East Lansing, MI; \\Department of Pediatrics, College of Human Medicine, Michigan State University, East Lansing, MI; ¶¶Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda. Received April 2017; accepted August 2017. Supported by NIH grant RO1 HD070723 (PIs: M.J.B., J.K.B.). S. M. Murray was supported by NIMH Global Mental Health training grant (MH103210). The study sponsor had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Disclosure: The authors declare no conflict of interest.

Funders	Funder number
National Institutes of Health
National Institute of Mental Health	MH103210
National Institute of Child Health and Human Development	R01HD070723

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/DBP.0000000000000510

Cite this

Boivin, M. J., Nakasujja, N., Familiar-Lopez, I., Murray, S. M., Sikorskii, A., Awadu, J., Shohet, C., Givon, D., Ruiseñor-Escudero, H., Schut, E. E., Opoka, R. O., & Bass, J. K. (2017). Effect of caregiver training on the neurodevelopment of HIV-exposed uninfected children and caregiver mental health: A ugandan cluster-randomized controlled trial. Journal of Developmental and Behavioral Pediatrics, 38(9), 753-764. https://doi.org/10.1097/DBP.0000000000000510

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abstract = "Objective: Early childhood development programs typically combine healthy nutrition and cognitive stimulation in an integrated model. We separately delivered these 2 components in a cluster-randomized controlled trial to evaluate their comparative effectiveness in promoting healthy child development and caregiver mental health. This is the first study to do so for HIV-affected children and their infected mothers. Methods: Two hundred twenty-one HIV-exposed but uninfected child (2-3 years old) and caregiver dyads in 18 geographic clusters in Eastern Uganda were randomized by cluster to receive biweekly individualized sessions of either (1) Mediational Intervention for Sensitizing Caregivers (MISC) training emphasizing cognitive stimulation or (2) Uganda Community Based Association for Child Welfare (UCOBAC) program that delivered health and nutrition training. Children were evaluated at baseline, 6 months, 1 year (training conclusion), and 1-year posttraining with the Mullen Scales of Early Learning (MSEL), the Color-Object Association Test for memory, the Early Childhood Vigilance Test of attention, and the Behavior Rating Inventory of Executive Function (BRIEF-parent). The Caldwell Home Observation for the Measurement of the Environment (HOME) was completed by observers to gauge caregiving quality after training. Caregiver depression/anxiety (Hopkins Symptom Checklist-25) and functionality (list of activities of daily living) were also evaluated. Data collectors were blinded to trial arm assignment. Results: Mediational Intervention for Sensitizing Caregivers resulted in significantly better quality of caregiving compared with UCOBAC midintervention with an adjusted mean difference (MadjDiff) of 2.34 (95% confidence interval [CI]: 1.54-3.15, p < .01), postintervention (MadjDiff 5 2.43, 95% CI: 1.61-3.25, p < .01), and at 1-year follow-up (MadjDiff 5 2.07, 95% CI: 1.23-2.90, p < .01). MISC caregivers reported more problems on the BRIEF for their child at 1-year posttraining only (p < .01). Caregiving quality (HOME) was significantly correlated with MSEL composite performance 1-year posttraining for both the MISC and the UCOBAC trial arms. Likewise, physical growth was significantly related to child development outcomes even though it did not differ between trial arms. Conclusion: Even though MISC demonstrated an advantage of improving caregiving quality, it did not produce better child cognitive outcomes compared with health and nutrition training. Trial Registration: clinicaltrials.gov Identifier: NCT01640561.",

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language = "אנגלית",

volume = "38",

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Boivin, MJ, Nakasujja, N, Familiar-Lopez, I, Murray, SM, Sikorskii, A, Awadu, J, Shohet, C, Givon, D, Ruiseñor-Escudero, H, Schut, EE, Opoka, RO & Bass, JK 2017, 'Effect of caregiver training on the neurodevelopment of HIV-exposed uninfected children and caregiver mental health: A ugandan cluster-randomized controlled trial', Journal of Developmental and Behavioral Pediatrics, vol. 38, no. 9, pp. 753-764. https://doi.org/10.1097/DBP.0000000000000510

Effect of caregiver training on the neurodevelopment of HIV-exposed uninfected children and caregiver mental health: A ugandan cluster-randomized controlled trial. / Boivin, Michael J.; Nakasujja, Noeline; Familiar-Lopez, Itziar et al.
In: Journal of Developmental and Behavioral Pediatrics, Vol. 38, No. 9, 2017, p. 753-764.

Research output: Contribution to journal › Article › peer-review

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AU - Nakasujja, Noeline

AU - Familiar-Lopez, Itziar

AU - Murray, Sarah M.

AU - Sikorskii, Alla

AU - Awadu, Jorem

AU - Shohet, Cilly

AU - Givon, Deborah

AU - Ruiseñor-Escudero, Horacio

AU - Schut, Elizabeth E.

AU - Opoka, Robert O.

AU - Bass, Judith K.

PY - 2017

Y1 - 2017

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Effect of caregiver training on the neurodevelopment of HIV-exposed uninfected children and caregiver mental health: A ugandan cluster-randomized controlled trial

Abstract

Bibliographical note

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UN SDGs

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