RESEARCH REPORT PLATFORM PRESENTATION

THE EFFECT OF A HOME STIMULATION PROGRAMME ON THE NEURODEVELOPMENTAL STATUS OF CHILDREN INFECTED WITH HIV IN SOWETO, SOUTH AFRICA. Potterton J¹, Stewart A², Cooper P³; ¹University of the Witwatersrand, Johannesburg, South Africa. ²University of the Witwatersrand, Johannesburg, South Africa. ³University of the Witwatersrand, Johannesburg, South Africa

PURPOSE: The purpose of this study was to establish whether a basic home stimulation programme would have an effect on the neurodevelopmental status of young children infected with HIV living in Soweto, South Africa. RELEVANCE: Paediatric HIV is a global health concern. South Africa has more HIV infected children than any other country in the world.HIV is neuropathic and has the potential to cause a significant encephalopathy with resultant developmental delay.All facets of development are affected. Physiotherapists in South Africa have not been involved in the long term management of children infected with HIV.No physiotherapy intervention studies have been done on children with HIV and developmental delay. PARTICIPANTS: 122 children under 2.5 years of age were recruited for this study. All children had a confirmed diagnosis of HIV and were cared for by a primary, adult caregiver.The caregivers of consecutive children attending a paediatric HIV clinic, at Chris Hani Baragwanath hospital in Soweto, who met the inclusion criteria were asked to participate in the study. METHODS: This study was a longitudinal, randomised clinical trial. 122 children were randomised into either the experimental or control group.The children in the experimental group received a home stimulation programme which was updated every three months at a routine clinic visit.The children in the control group received no intervention. All children were assessed using the Bayley Scales of Infant development at baseline, six months and twelve months.The Mental Developmental Index (MDI)and Motor Developmental Index (PDI) were calculated for each child at each visit.Ethical clearance and informed consent were obtained prior to data collection. ANALYSIS: Demographic data were summarised using descriptive statistics.Change in the developmental status of the two groups over time was assessed using ANOVA.Step wise multiple regression analysis was used to identify predictors of developmental status as well as factors predictive of improvement in developmental status over time. RESULTS: The two groups were well matched for all variables at baseline.At baseline 52% of the children had severe mental delay and 72% had severe motor delay.The children in the experimental group showed significantly greater improvement in MDI(p = 0.01) and PDI (p = 0.02)scores over time. Weight-for-age and CD4 counts were predictive of developmental status. CONCLUSIONS: Children infected with HIV in South Africa are at risk of severe developmental delay. A basic home stimulation programme resulted in sinificant improvements in mental and motor development in young children infected with HIV. IMPLICATIONS: Physiotherapist need to be aware of the impact of HIV on the developing central nervous system. Developmental assessment and management should be an integral part of services for children infected with HIV.The long term rehabilitation needs of children infected with HIV need to be investigated. KEYWORDS: HIV, neurodevelopment, encephalopathy, children. FUNDING ACKNOWLEDGEMENTS: Medical Research Council of South Africa. AIDS Research Institute, University of the Witwatersrand. CONTACT: Joanne.Potterton@wits.ac.za

ETHICS COMMITTEE: The Committee for Research on Human Subjects, University of the Witwatersrand. (Certificate no: M03-05-68)