PDF(Pubmed)
Abstract：
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).
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.
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]).
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.
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.
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]).
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.
摘要：
背景：暴露于HIV且未感染（CHEU）的儿童正在增加，具有神经认知发育不良的潜在风险。我们通过护理活动（次要）对儿童的神经认知发育和母亲抑郁症状（主要）进行了干预。
方法：这项研究是在eSwatini的六个干预和九个比较产前护理/预防垂直传播（ANC/PVT）HIV诊所中进行的。我们招募了孕妇，并在9个月和18个月测量了婴儿的发育。mothers2mothers（m2m）设计并实施了基于诊所-家庭-社区的干预措施。我们测量了婴儿的神经发育,母亲抑郁症状和护理活动与早期学习的马伦量表（MSEL），爱丁堡产后抑郁量表，家庭库存和家庭护理指标。我们将线性混合效应回归模型与临床随机效应拟合，以比较干预与比较组，和广义结构方程模型来评估中介，适应混杂因素。
结果：母婴对（n=429）参加了2016年1月至2018年5月。社会人口统计学特征在两组之间保持平衡，除了比较组中城市周边地区与农村居住地的比率更高，单身母亲与已婚母亲的比率更高。18个月的保留率为82%(180/220)干预，79%(166/209)比较臂，25名婴儿死亡。干预MSEL评分显著，谦虚地，接受语言较高(55.7[95%CI54.6，56.9]与53.7[95%CI52.6，54.8])，表达语言（42.5[95%CI41.6，39.8]与40.8[95%CI39.8，41.7]）和复合MSEL（85.4[95%CI83.7，84.5]与82.7[95%CI81.0，84.5])，在产妇抑郁症状或母婴互动观察方面没有差异。干预书籍分享得分较高（0.63vs.0.41)并介导对MSEL评分的影响(间接影响，p值≤0.024)。与对照组相比，干预措施对视觉接收和表达语言得分的直接影响明显更高（系数1.93[95％CI0.26，3.60]和1.66[95％CI0.51，2.79]）。
结论：培养护理干预措施可以纳入ANC/PVT诊所-家庭-社区项目。干预,通过互动护理活动调解，CHEU的语言发展得分提高。与当地团队合作，m2m,设计和实施与文化相关的干预措施说明了影响与儿童神经发育相关的亲子游戏和学习活动的能力。
方法：这项研究是在eSwatini的六个干预和九个比较产前护理/预防垂直传播（ANC/PVT）HIV诊所中进行的。我们招募了孕妇，并在9个月和18个月测量了婴儿的发育。mothers2mothers（m2m）设计并实施了基于诊所-家庭-社区的干预措施。我们测量了婴儿的神经发育,母亲抑郁症状和护理活动与早期学习的马伦量表（MSEL），爱丁堡产后抑郁量表，家庭库存和家庭护理指标。我们将线性混合效应回归模型与临床随机效应拟合，以比较干预与比较组，和广义结构方程模型来评估中介，适应混杂因素。
结果：母婴对（n=429）参加了2016年1月至2018年5月。社会人口统计学特征在两组之间保持平衡，除了比较组中城市周边地区与农村居住地的比率更高，单身母亲与已婚母亲的比率更高。18个月的保留率为82%(180/220)干预，79%(166/209)比较臂，25名婴儿死亡。干预MSEL评分显著，谦虚地，接受语言较高(55.7[95%CI54.6，56.9]与53.7[95%CI52.6，54.8])，表达语言（42.5[95%CI41.6，39.8]与40.8[95%CI39.8，41.7]）和复合MSEL（85.4[95%CI83.7，84.5]与82.7[95%CI81.0，84.5])，在产妇抑郁症状或母婴互动观察方面没有差异。干预书籍分享得分较高（0.63vs.0.41)并介导对MSEL评分的影响(间接影响，p值≤0.024)。与对照组相比，干预措施对视觉接收和表达语言得分的直接影响明显更高（系数1.93[95％CI0.26，3.60]和1.66[95％CI0.51，2.79]）。
结论：培养护理干预措施可以纳入ANC/PVT诊所-家庭-社区项目。干预,通过互动护理活动调解，CHEU的语言发展得分提高。与当地团队合作，m2m,设计和实施与文化相关的干预措施说明了影响与儿童神经发育相关的亲子游戏和学习活动的能力。
