Admin Sup FACET: Family Dynamics and Child Neurodevelopment in Botswana

Massachusetts General Hospital, Boston MA

Investigators

Linked publications & trials

Abstract

In sub-Saharan Africa (SSA) is home to 90% of the nearly 16 million children who are HIV-exposed uninfected (CHEU). This population has been shown to be at increased risk of neurodevelopmental delays compared to their HIV-unexposed peers. The World Health Organization and UNICEF advocate for use of the Nurturing Care Framework, consisting of five facets of care – health, nutrition, responsive caregiving, safety from threats, and opportunities for learning – a framework shown to optimize child neurodevelopment when fully implemented. Given that families and caregivers are the primary source of a child's nurturing care, it is important to explore associations between family structures, home environment, and child neurodevelopment, particularly among families affected by HIV. In Botswana, a high prevalence HIV setting, one in four children under 15 years of age are CHEU, and fewer than 10% of parenting couples are formally married. Given the fact that the Nurturing Care Framework has never been programmatically implemented in Botswana and caregiving structures have not been well described, understand caregiving within this unique context of low marriage rates and high HIV prevalence and associations with developmental outcomes among CHEU is of critical public health importance. The proposed FACET study (Family Dynamics and Child Neurodevelopment in Botswana) will leverage an ongoing birth cohort within the FLOURISH Study (Following Longitudinal Outcomes to Understand, Report, Intervene and Sustain Health of Infants, Children and Adolescents who are HIV-Exposed Uninfected; R33 HD103099; Principal Investigators: Powis, Jao, Makhema) currently enrolling up to 300 pregnant persons, half of which are living with HIV, and their infants to a) (Aim 1) to characterize patterns of household composition and family dynamics for caregiving, and the role of nurturing care in promoting healthy neurodevelopment among children in Botswana using a focus group discussion format; and b) employing a mixed-methods design (Aim 2), assess the associations between child HIV exposure status, caregiver relationship factors, and child neurodevelopment. The Caregiver Reported Early Developmental Index (CREDI), a parent-reported assessment tool that has been validated for use across 26 countries, 17 of which are low-and-middle income countries, including Botswana, will be administered to FACET participating mothers when their child reaches six-months of life. Simultaneously, qualitative data will be collected from up to 30 mothers participating in a second round of focus group discussions exploring how their relationships with their partners, paternal involvement in caregiving, home environment factors (e.g., food insecurity, intimate partner violence), and child temperament may impact their caregiving. Convergent parallel triangulation will be employed to jointly interpret quantitative and qualitative research findings. Research is urgently needed to assess the combined impact of fetal HIV exposure and family structures on child neurodevelopment.