Improved caregiver training helps HIV-infected children

Children born with HIV can live longer and richer lives if their caregivers receive training in ways to enhance the children’s development, according to research led by Michigan State University.

The program also reduces depression in the caregivers which, in most cases, are the children’s HIV-infected mothers, MSU researcher Michael Boivin and colleagues report in The Journal of Pediatrics.

An HIV diagnosis once all but guaranteed an African child would die within a few years, but more effective and widely available drugs have made it commonplace for children there to live with the disease into or beyond adolescence.

Still, with gravely ill caregivers - many of whom must also work long hours in the fields to provide food - these kids miss out on the affection and regular interaction that are crucial for their physical, social and cognitive development in early childhood, said Boivin, professor in the departments of Psychiatry and of Neurology and Ophthalmology.

“Better access to treatment has clinically stabilized these children and extended their lives, but their quality of life is still very much at risk,” Boivin said. “The effects of the disease on their development and the compromised caregiving available to them compound the public health challenges already faced by African children in resource-poor settings.”

Funded by the National Institutes of Health, the study involved a training program called Mediational Intervention for Sensitizing Caregivers, or MISC, which uses day-to-day interaction at home to enhance children’s social skills, language and cognitive ability.

“MISC is about training mothers or other caregivers on ways they can be sensitive to their child’s natural tendencies to learn, and to direct those tendencies in everyday life to enrich the child’s development,” said Boivin.

The study involved 120 preschool-aged children with HIV living in rural Uganda. Their primary caregivers were randomly assigned to receive childcare training through MISC or through an education program focused on improving children’s health and nutrition.

After a year, the children whose caregivers received the MISC training showed significantly more developmental progress than the others, with particularly strong gains in memory and learning skills.

Somewhat surprisingly, there were significantly fewer deaths from diseases that take advantage of the patient’s compromised immune system in the MISC group than among other children, suggesting the training may help pediatric HIV patients live longer.

Boivin said it could be that MISC-trained caregivers “became more attuned to their children’s health needs and were more likely to seek medical help in a timely manner when the children are fighting an opportunistic illness.”

Caregivers in the MISC group also were significantly less depressed six months into the study than those in the other group, perhaps because of the social support they received during MISC training.