Cargando…

Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe

INTRODUCTION: 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. METHODS: We conducted a cluster-randomised trial from 2016 to 2018. Clusters were catchments surr...

Descripción completa

Detalles Bibliográficos
Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747895/
https://www.ncbi.nlm.nih.gov/pubmed/31565411
http://dx.doi.org/10.1136/bmjgh-2019-001651
_version_ 1783451999216336896
author 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
author_facet 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
author_sort Mebrahtu, Helen
collection PubMed
description INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. TRIAL REGISTRATION NUMBER: PACTR201701001387209.
format Online
Article
Text
id pubmed-6747895
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-67478952019-09-27 Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe 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 BMJ Glob Health Research INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. TRIAL REGISTRATION NUMBER: PACTR201701001387209. BMJ Publishing Group 2019-09-11 /pmc/articles/PMC6747895/ /pubmed/31565411 http://dx.doi.org/10.1136/bmjgh-2019-001651 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Research
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
Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe
title Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe
title_full Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe
title_fullStr Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe
title_full_unstemmed Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe
title_short Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe
title_sort effects of parenting classes and economic strengthening for caregivers on the cognition of hiv-exposed infants: a pragmatic cluster randomised controlled trial in rural zimbabwe
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747895/
https://www.ncbi.nlm.nih.gov/pubmed/31565411
http://dx.doi.org/10.1136/bmjgh-2019-001651
work_keys_str_mv AT mebrahtuhelen effectsofparentingclassesandeconomicstrengtheningforcaregiversonthecognitionofhivexposedinfantsapragmaticclusterrandomisedcontrolledtrialinruralzimbabwe
AT simmsvictoria effectsofparentingclassesandeconomicstrengtheningforcaregiversonthecognitionofhivexposedinfantsapragmaticclusterrandomisedcontrolledtrialinruralzimbabwe
AT mupambireyizivai effectsofparentingclassesandeconomicstrengtheningforcaregiversonthecognitionofhivexposedinfantsapragmaticclusterrandomisedcontrolledtrialinruralzimbabwe
AT rehmanandream effectsofparentingclassesandeconomicstrengtheningforcaregiversonthecognitionofhivexposedinfantsapragmaticclusterrandomisedcontrolledtrialinruralzimbabwe
AT chingonorudo effectsofparentingclassesandeconomicstrengtheningforcaregiversonthecognitionofhivexposedinfantsapragmaticclusterrandomisedcontrolledtrialinruralzimbabwe
AT matsikireedward effectsofparentingclassesandeconomicstrengtheningforcaregiversonthecognitionofhivexposedinfantsapragmaticclusterrandomisedcontrolledtrialinruralzimbabwe
AT malabarickie effectsofparentingclassesandeconomicstrengtheningforcaregiversonthecognitionofhivexposedinfantsapragmaticclusterrandomisedcontrolledtrialinruralzimbabwe
AT weisshelena effectsofparentingclassesandeconomicstrengtheningforcaregiversonthecognitionofhivexposedinfantsapragmaticclusterrandomisedcontrolledtrialinruralzimbabwe
AT ndlovupatience effectsofparentingclassesandeconomicstrengtheningforcaregiversonthecognitionofhivexposedinfantsapragmaticclusterrandomisedcontrolledtrialinruralzimbabwe
AT cowanfrancesm effectsofparentingclassesandeconomicstrengtheningforcaregiversonthecognitionofhivexposedinfantsapragmaticclusterrandomisedcontrolledtrialinruralzimbabwe
AT sherrlorraine effectsofparentingclassesandeconomicstrengtheningforcaregiversonthecognitionofhivexposedinfantsapragmaticclusterrandomisedcontrolledtrialinruralzimbabwe