Peer-reviewed article
A trial of nurturing care among children who are HIV‐exposed and uninfected in eSwatini
Andrea Ruff, Xolisile Dlamini, Bareng A. S. Nonyane, Nicole Simmons, Duncan Kochelani et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tested a nurturing care intervention delivered through HIV clinics in eSwatini to support the neurocognitive development of children born to HIV-positive mothers but who are not themselves infected. The intervention, implemented by mothers2mothers, was delivered in clinic, home and community settings and included activities like book-sharing to promote parent-child interaction. Children in the intervention group showed modest but significant improvements in language development at 18 months, with benefits mediated through increased caregiving activities such as interactive book-sharing.
Key points
- Intervention children had significantly higher receptive language (55.7 vs 53.7), expressive language (42.5 vs 40.8), and composite developmental scores (85.4 vs 82.7) at 18 months
- Book-sharing scores were higher in the intervention group (0.63 vs 0.41) and statistically mediated the effect on developmental scores
- The intervention was integrated into existing antenatal care and prevention of vertical transmission (ANC/PVT) HIV clinic services
- 18-month retention was high: 82% intervention arm and 79% comparison arm, with 25 infant deaths across both groups
- No significant differences were found in maternal depressive symptoms or observed mother-child interactions between groups
Limitations
The study did not measure longer-term developmental outcomes beyond 18 months, so it cannot tell us whether language development benefits persist into early childhood or translate into later school readiness. The study cannot definitively explain why maternal depressive symptoms and observed interactions did not differ between groups despite improvements in development scores.
Abstract
INTRODUCTION: Children who are HIV-exposed and uninfected (CHEU) are a growing population at potential risk of poor neurocognitive development. We tested a nurturing care intervention on children's neurocognitive development and maternal depressive symptoms (primary) with mediation through caregiving activities (secondary). METHODS: This study was conducted among six intervention and nine comparison antenatal-care/prevention of vertical transmission (ANC/PVT) HIV clinics in eSwatini. We enrolled pregnant women and measured infant development at 9 and 18 months. mothers2mothers (m2m) designed and implemented the clinic-home-community-based intervention. We measured infants' neurodevelopment, maternal depressive symptoms and caregiving activities with the Mullen Scales of Early Learning (MSEL), Edinburgh Postnatal Depression Scale, HOME Inventory and Family Care Indicators. We fitted linear mixed effects regression models with clinic random effects to compare intervention versus comparison arms, and generalised structural equation models to evaluate mediation, adjusting for confounders. RESULTS: Mother-infant pairs (n = 429) participated between January 2016 through May 2018. Socio-demographic characteristics were balanced between arms except for higher rates of peri-urban versus rural residence and single versus married mothers in the comparison group. The 18 month retention was 82% (180/220) intervention, 79% (166/209) comparison arm, with 25 infant deaths. Intervention MSEL scores were significantly, and modestly, higher in receptive language (55.7 [95% CI 54.6, 56.9] vs. 53.7 [95% CI 52.6, 54.8]), expressive language (42.5 [95% CI 41.6, 39.8] vs. 40.8 [95% CI 39.8, 41.7]) and composite MSEL (85.4 [95% CI 83.7, 84.5] vs. 82.7 [95% CI 81.0, 84.5]), with no difference in maternal depressive symptoms or in observations of mother-child interactions. Intervention book-sharing scores were higher (0.63 vs. 0.41) and mediated the effect on MSEL scores (indirect effect, p-values ≤ 0.024). The direct effects on visual reception and expressive language scores were significantly higher in the intervention compared to the comparison arm (coefficients 1.93 [95% CI 0.26, 3.60] and 1.66 [95% CI 0.51, 2.79, respectively]). CONCLUSIONS: Nurturing care interventions can be integrated into ANC/PVT clinic-home-community programmes. The intervention, mediated through interactive caregiving activities, increased language development scores among CHEU. Partnering with a local team, m2m, to design and implement a culturally relevant intervention illustrates the ability to impact parent-child play and learning activities that are associated with children's neurodevelopment.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Clinic-home-community-based nurturing care intervention designed and implemented by mothers2mothers, including activities to promote parent-child interaction and play (such as book-sharing)
- Population
- Pregnant women and their infants born HIV-exposed and uninfected in eSwatini, enrolled between January 2016 and May 2018
Key finding
Receptive language scores 2.0 points higher in intervention group at 18 months (55.7 vs 53.7)