Prenatal antiretroviral therapy initiation and school readiness among HIV-exposed, uninfected children in Tanzania
Nandita Perumal, PhD MPH
BACKGROUND: Over 14.8 million children aged 0 to 14 years are estimated to be exposed to HIV, but are uninfected (HEU); 13 million of whom reside in sub-Saharan Africa. Children who are HEU are at greater risk of poor neurodevelopmental outcomes later in life, which may in part be due to exposure to antiretroviral therapy (ART) in-utero. GAP: Studies have reported inconsistent findings on the role of ART exposure in-utero and timing of ART initiation during pregnancy on child health and development. Evidence on the role of ART initiation during pregnancy and child neurodevelopment beyond the first two years of life from low resource settings, where there is a high burden of HIV infection with multiple poverty, nutritional, and sociodemographic risk factors at play, are lacking. HYPOTHESIS: We hypothesized that ART initiation earlier in pregnancy will be associated with poorer neurodevelopment and school readiness outcomes among HEU children aged 3-6 years, and that the relationship will be stronger among some subgroups of children. METHODS: We will conduct a cross-sectional follow-up survey of HEU children 3-6 years of age who were born to pregnant women living with HIV previously enrolled in a prenatal vitamin D supplementation trial in Dar es Salaam, Tanzania. Pregnant women in this trial were either previously on or initiated ART at trial enrolment. New data on child anthropometry, neurodevelopment, and school readiness at 3-6 years of age will be collected. RESULTS: Pending. IMPACT: With increasing availability and accessibility to effective ART, the number of HEU children is increasing. The results of this study will provide new evidence on the potential implications of ART timing during pregnancy on preschool-aged children’s health and development, in the context of multiple adversities, and help identify target populations for parenting interventions to improve child health and development.