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
Institute of Global Health, University College London, London, UK.
MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
BMJ Glob Health. 2019 Sep 11;4(5):e001651. doi: 10.1136/bmjgh-2019-001651. eCollection 2019.
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.
We conducted a cluster-randomised trial from 2016 to 2018. Clusters were catchments surrounding clinics, allocated (1:1) 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.
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).
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.
PACTR201701001387209.
暴露于艾滋病病毒的儿童表现出发育迟缓的迹象。我们评估了一项针对津巴布韦0至2岁暴露于艾滋病病毒儿童的照料者的实用多组分干预措施的影响。
我们在2016年至2018年进行了一项整群随机试验。整群为诊所周围的集水区，按1:1分配至国家艾滋病病毒指南标准护理组或标准护理加一个包含18节课程的小组干预组，该干预组包括：i）幼儿刺激（ECS）和育儿培训，并进行家访以强化技能和维持艾滋病病毒护理；ii）经济强化。在基线后12个月（干预完成后4.5个月）测量的主要结局包括：i）使用马伦早期学习综合评分测量的全球儿童发育情况；ii）维持艾滋病病毒护理。分析采用混合效应回归以考虑聚类情况，并对基线预后因素进行最小程度调整，且按意向性分析。
随机分配了30个整群，每组15个。招募了574对母婴，随访时保留率为89.5%。281名中有91名（32.4%）被记录为接受了完整的干预方案，其中161/281（57.3%）参加了≥14节ECS课程。没有证据表明干预对全球儿童发育有影响（干预组均值为88.1，标准护理组均值为87.6；调整后均值差异=0.06；95%CI -2.68至2.80；p=0.97）或婴儿护理维持情况（错过最近一次艾滋病病毒检测的儿童比例：干预组为21.8%，标准护理组为16.9%，p=0.18）。有微弱证据表明干预组中存在父母压力问题的照料者比例有所降低（调整后比值比（aOR）=0.69；95%CI 0.45至1.05；p=0.08），且有更强证据表明父母的困扰问题具体有所减少（干预组得分高于临界值的比例为17.4%，标准护理组为29.1%；aOR=0.56；95%CI 0.35至0.89；p=0.01）。
这项多组分干预措施在完成后4.5个月内对儿童发育结局没有影响，但对父母的困扰有影响。孕产妇心理健康仍然是一个高度优先事项。
PACTR201701001387209。
