Peer-reviewed article
Game-based Cognitive Training for School-age Children Living With or Exposed to HIV: A Randomized Controlled Trial in Uganda and Malawi.
Familiar-Lopez I, Sikorskii A, Winn B, Wambuzi L, Dadabhai S et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This randomized controlled trial tested whether a mobile game-based cognitive training program could improve thinking and learning skills in children aged 5-12 years who were living with HIV, exposed to HIV, or uninfected. The study involved 599 children in Uganda and Malawi who either received 12 weeks of the intervention or joined a waitlist. Results differed between countries: in Uganda, children who played the games showed better learning and processing scores, but in Malawi, some cognitive measures actually decreased in the intervention group.
Key points
- 599 children enrolled across Uganda and Malawi, including those with perinatally acquired HIV (120), HIV-exposed uninfected (239), and HIV-unexposed uninfected (240)
- In Uganda, intervention group showed significantly higher Learning composite scores (3.34 points), Mental Processing Index (2.39 points), and Nonverbal Index scores on standardized tests immediately after the 12-week program
- In Malawi, the intervention group showed lower Planning scores (-2.22 points) and Delayed Recall scores (-2.87 points) compared to waitlist, indicating potential harm
- Cogstate Maze Learning improvements in Uganda persisted at 6-month follow-up
- Effects were modest and varied substantially by geographic context and HIV exposure status
Limitations
The study shows context-specific and sometimes contradictory results between Uganda and Malawi, limiting generalizability of findings. The document does not explain why outcomes differed so dramatically by country or provide detailed analysis of implementation factors that may have influenced effectiveness.
Abstract
Objective Children with perinatally acquired HIV (PHIV) and those exposed to HIV but uninfected (HEU) are at increased risk for adverse cognitive and behavioral outcomes, particularly in sub-Saharan Africa. This study evaluated the efficacy of brain powered games (BPG), a mobile computerized cognitive rehabilitation intervention, on neurocognitive outcomes among children with PHIV, HEU, and HIV unexposed uninfected children (HUU) in Uganda and Malawi. Methods We conducted a randomized controlled trial in Uganda and Malawi enrolling 599 children aged 5 to 12 years (PHIV = 120, HEU = 239, HUU = 240). Participants were randomized to a 12-week BPG intervention or a waitlist. Neuropsychological outcomes were assessed at baseline, postintervention, and 6-month follow-up using the Kaufman Assessment Battery for Children Second Edition (KABC-II), test of variables of attention, and Cogstate. Linear mixed-effects models estimated intervention effects, separately by country. Results In Uganda, children receiving BPG demonstrated higher Learning composite scores (3.34; 95% CI, 1.03-5.65), Mental Processing Index scores (2.39; 95% CI, 0.78-4.01), and Nonverbal Index scores in KABC-II (2.28; 95% CI, 0.27-4.28) immediately postintervention compared with waitlist. Cogstate Maze Learning was higher postintervention (0.02; 95% CI, 0.004-0.043) and at 6 months (0.02; 95% CI, 0.003-0.040). In Malawi, Planning scores (-2.22; 95% CI, -4.39 to -0.05) and Delayed Recall scores (-2.87; 95% CI, -5.22 to -0.51) in KABC-II were lower in the intervention arm postintervention, whereas Cogstate Identification scores were higher (-0.03; 95% CI, -0.05 to -0.004). Conclusion Mobile cognitive training produced modest, domain-specific cognitive benefits, with effects varying by context and HIV exposure status.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Brain Powered Games (BPG): a mobile computerized cognitive rehabilitation intervention delivered over 12 weeks
- Population
- School-age children aged 5-12 years in Uganda and Malawi, including those with perinatally acquired HIV (PHIV), HIV-exposed uninfected (HEU), and HIV-unexposed uninfected (HUU)
Key finding
Uganda: Learning composite scores 3.34 points higher (95% CI 1.03-5.65) in intervention group postintervention