Bass Judith K, Opoka Robert, Familiar Itziar, Nakasujja Noeline, Sikorskii Alla, Awadu Jorem, Givon Deborah, Shohet Cilly, Murray Sarah M, Augustinavicius Jura, Mendelson Tamar, Boivin Michael
aDepartment of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA bDepartment of Pediatrics and Child Health, Makerere University, Kampala, Uganda cDepartment of Psychiatry, Michigan State University, East Lansing, Michigan, USA dDepartment of Psychiatry, Bar Ilan University, Ramat-Gan, Israel eSchool of Education, Michigan State University, East Lansing, Michigan, USA fSchool of Education, Bar Ilan University, Ramat-Gan, Israel gDepartment of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, USA.
AIDS. 2017 Aug 24;31(13):1877-1883. doi: 10.1097/QAD.0000000000001563.
HIV infection places children at neurodevelopmental risk; for young children in poverty, risk is compounded by compromised caregiving quality. The mediational intervention for sensitizing caregivers (MISC) program trained caregivers on fostering daily interactions with young children. We hypothesized that MISC could enhance neurodevelopment of rural Ugandan HIV-infected children and improve mental health outcomes of their caregivers, which might mediate improved caregiving quality.
A randomized trial of HIV-infected young children (ages 2-5 years) and their female caregivers; cluster randomization was to MISC or a nutrition curriculum.
A total of 18 geographic clusters in rural Uganda.
Children and caregivers were evaluated at baseline, 6 months, 1 year, and 1-year post-training.
Mullen Scales of Early Learning, the Color-Object Association Test for memory, the Early Childhood Vigilance Test of attention, and the Behavior Rating Inventory of Executive Function for the children. Caregivers completed measures of depression and anxiety symptoms and daily functioning.
MISC had a significant impact on postintervention receptive language (adjusted mean difference = 3.13, 95% confidence interval 0.08, 6.18) that persisted at 1-year follow-up. MISC caregivers reported significantly less functional impairment postprogram (adjusted mean difference = -0.15, 95% confidence interval -0.28, -0.01). Other outcomes were NS.
Both intervention conditions resulted in improvements in the study children over time. MISC showed additional impacts on child language and caregiver well-being. Future directions that include assessing the extent enhanced language development resulting from improved caregiving may better prepare impoverished children for school.
感染艾滋病毒会使儿童面临神经发育风险；对于贫困家庭的幼儿来说，因育儿质量受损，这种风险会进一步加剧。照顾者敏感化调解干预（MISC）项目对照顾者进行培训，以促进其与幼儿的日常互动。我们假设，MISC可以促进乌干达农村感染艾滋病毒儿童的神经发育，并改善其照顾者的心理健康状况，这可能会调解育儿质量的提高。
对感染艾滋病毒的幼儿（2至5岁）及其女性照顾者进行随机试验；整群随机分为MISC组或营养课程组。
乌干达农村地区共18个地理区域。
在基线、6个月、1年和培训后1年对儿童和照顾者进行评估。
儿童的穆伦早期学习量表、记忆的颜色-物体联想测试、注意力的幼儿警觉性测试和执行功能行为评定量表。照顾者完成抑郁和焦虑症状及日常功能的测量。
MISC对干预后的接受性语言有显著影响（调整后平均差异=3.13，95%置信区间0.08，6.18），在1年随访时仍然存在。MISC组的照顾者在项目结束后报告的功能损害明显较少（调整后平均差异=-0.15，95%置信区间-0.28，-0.01）。其他结局无统计学意义。
随着时间的推移，两种干预条件都使研究中的儿童有所改善。MISC对儿童语言和照顾者幸福感有额外影响。未来的方向包括评估因育儿改善而增强的语言发展程度，这可能会让贫困儿童更好地为上学做好准备。
