Researching Interventions and Implementation Strategies to Evaluate the Health and Development of Children Affected by HIV in Southern and Eastern Africa (RISE)

University Of Washington, Seattle WA

Investigators

Abstract

An estimated 16.1 million children ≤ 14 years of age are HIV exposed and uninfected (CHEU) globally, with the majority residing in Eastern and Southern Africa. Better access to HIV care, especially for pregnant and parenting women living with HIV has resulted in a decreasing number of children acquiring HIV perinatally, and consequently, an increasing number of CHEU. However, starting life HIV free has not ensured that these children achieve comparable health and developmental outcomes compared to children born HIV-unexposed (CHU_. There is a growing body of evidence demonstrating increased risk of neurodevelopmental delays among CHEU compared to CHU. However, health systems, especially in high prevalence HIV regions, have not yet developed specific programming for CHEU at the highest risk of suboptimal neurodevelopment, beyond ensuring that programming is in place to prevent infant acquisition of HIV. Our program, entitled “Researching Interventions and Implementation Strategies to Evaluate the Health and Development of Children with Perinatal HIV Exposure in Southern and Eastern Africa” (RISE), is designed to a) generate evidence on mechanisms underlying neurodevelopment disparities of CHEU compared to their peers born HIV-unexposed; b) test a package of interventions offered in pregnancy through a child’s second year of life to optimize neurodevelopment; c) validate a risk score designed to identify CHEU at risk for suboptimal neurodevelopment and use an implementation science approach to assess the acceptability and feasibility of introducing the risk score tool into routine child health visits; d) and use routinely collected regional and national health data, as well as data around social determinants of health to quantify health and neurodevelopmental disparities between populations of CHEU and CHU to facilitate iterative data-driven improvement of maternal-child health policy and programming by addressing identified disparities. It will be of significant public health importance to minimize the time from evidence generation from RISE Projects to policy and programming implementation. In order to close this “know- do” gap, the RISE Dissemination and Engagement Core will l support four RISE Projects teams in Botswana, Kenya, South Africa and Zimbabwe to 1)Engage key stakeholders in each country to map the network of partners and community collaborators (PCC) and their priorities for evidence in the care of CHEU, convening workshops with representatives of Ministries of Health and Education, local health institutions and non-governmental organizations, community gatekeepers, advocates for children HIV-exposed uninfected, and representatives of international organizations and NGOs (e.g. WHO, UNICEF, UNAIDS); 2) Develop a country-tailored dissemination toolkit for each RISE project, modifying the toolkit further by engaging PCC for additional input; and 3) Supporting RISE country teams to disseminate RISE Project research findings to national and sub- national PCC, and to international organizations, with post-dissemination assessment of penetration and impact on policy and programming.