Predicting neurodevelopmental risk in children born to mothers living with HIV in Kenya

预测肯尼亚艾滋病毒感染者母亲所生儿童的神经发育风险

• 批准号: 10557155
• 负责人: Megan Song McHenry
• 金额: $ 63.12万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-09 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10557155
• 关键词: 2 year old; Acquired Immunodeficiency Syndrome; Affect; Africa South of the Sahara; African; Age Months; Anti-Retroviral Agents; Assessment tool; Behavior; Biological; Biological Factors; Biological Markers; Birth; Birth History; Breast Feeding; Child; Child Behavior Checklist; Clinical; Cognition; Cohort Studies; Communicable Diseases; Country; Data; Databases; Development; Diarrhea; Education; Enrollment; Epidemiology; Etiology; Exposure to; Face; Fetal Alcohol Exposure; Future; Goals; HIV; Health; Home environment; Human; Infant; Inflammatory; International; Intervention; Iron deficiency anemia; Kenya; Knowledge; Language; Lead levels; Life; Longitudinal Studies; Longitudinal cohort; Malaria; Malnutrition; Measles; Measures; Meningitis; Mental Health; Mission; Modeling; Monitor; Morbidity - disease rate; Mothers; Motor; Newborn Infant; Outcome; Outcome Study; Participant; Perinatal; Pharmaceutical Preparations; Pneumonia; Population; Poverty; Predictive Factor; Pregnancy; Pregnant Women; Provider; Psychosocial Factor; Punishment; Quality of life; Recording of previous events; Research; Risk; Risk Assessment; Risk Factors; Sanitation; Stress; Surveillance Program; Toddler; Tuberculosis; United States National Institutes of Health; Water; Woman; Work; antiretroviral therapy; cohort; disability; evidence base; health care availability; improved; neurodevelopment; peer; pharmacovigilance; postnatal; predictive tools; prevention service; prospective; psychosocial; social; social factors; sociodemographic factors; sociodemographics; success; tool; transmission process; violence exposure

PROJECT SUMMARY Children who are HIV-exposed but uninfected (HEU) may have worse neurodevelopmental outcomes compared to their HIV-unexposed and uninfected (HUU) peers. However, the etiology of this potential association is unclear. With a growing population of children who are HIV-exposed, making up over 15% of children in some countries, there is a critical need to identify evidence-based risk factors associated with poor neurodevelopment to appropriately target interventions. The specific objectives of this application are: (1): to evaluate potential risk factors longitudinally over the first 2 years of life in children who are HEU and HUU and define those associated with worse neurodevelopmental outcomes at 24 months, and (2) to create a risk assessment tool to predict which children will have worse neurodevelopmental outcomes. The central hypothesis is that children who are HEU and HUU will have different neurodevelopmental outcomes; and that we can use risk factors to predict which children are at risk for worse outcomes before 2 years of age. The rationale for developing this tool is to identify children at risk for worse neurodevelopmental outcomes earlier to allow for targeted intervention. In Aim 1, we will evaluate the potential risk factors for poor neurodevelopment in young children. In Aim 2, we will compare neurodevelopmental outcomes between 24-month-old children who are HEU and those who are HUU in Kenya. In Aim 3, we will create a risk assessment tool to predict which children are at risk for worse neurodevelopmental outcomes at 24 months of age. This study will leverage an existing cohort to prospectively enroll 500 children who are HEU and 500 who are HUU and longitudinally follow them from birth to 24 months of age. Within the first aim, the following factors will be measured every 6 months: infectious morbidity, biological risk factors, and social risk factors (both sociodemographic and psychosocial). We will then compare these factors between children who are HEU and HUU. Within the second aim, we will measure neurodevelopment (cognition, language, motor, and behavior) in children at 24 months of age using the Child Behavior Checklist and the Bayley Scales of Infant and Toddler Development, 3rd edition, which our team has culturally-adapted and internally validated for use in Kenya. We will then compare neurodevelopmental outcomes between children who are HEU and HUU, providing well-powered data to determine whether differences truly exist between the groups. Finally, within the third aim, we will use generalized linear mixed modeling to quantify associations among multiple factors on child neurodevelopment and create a risk assessment tool for use in children <24 months. The proposed study is significant, as we will determine interconnected factors associated with worse neurodevelopmental outcomes in children who are HEU and HUU in Kenya. The resulting risk assessment tool will allow clinical providers to institute interventions for children at risk for worse neurodevelopmental outcomes earlier. This work will also create a longitudinal cohort of children exposed to antiretroviral therapy and HIV that may be monitored for future studies.

项目摘要 暴露于艾滋病毒但未感染的儿童（HEU）可能有更差的神经发育结果 与他们的HIV未暴露和未感染（HUU）同龄人相比。然而，这种潜在的病因 关联尚不清楚。随着越来越多的儿童暴露于艾滋病毒，占15%以上， 在一些国家，迫切需要确定与贫穷有关的循证风险因素， 神经发育，以适当的目标干预。本申请的具体目的是：（1）： 纵向评估高浓缩铀和高浓缩铀儿童生命头2年的潜在风险因素， 定义与24个月时神经发育结局较差相关的因素，以及（2）产生风险 评估工具，以预测哪些儿童将有更差的神经发育结果。中央 假设是高浓缩铀和高浓缩铀的儿童将有不同的神经发育结果; 我们可以使用风险因素来预测哪些儿童在2岁之前有更坏结果的风险。的 开发该工具的基本原理是更早地识别出有神经发育不良风险的儿童， 允许有针对性的干预。在目标1中，我们将评估神经发育不良的潜在危险因素， 年幼的孩子。在目标2中，我们将比较24个月大的儿童， 是高浓缩铀和肯尼亚的高浓缩铀。在目标3中，我们将创建一个风险评估工具来预测 儿童在24个月大时有可能出现更差的神经发育结果。这项研究将利用一个 现有队列前瞻性招募500名高浓缩铀儿童和500名高浓缩铀儿童， 从出生到24个月大。在第一个目标内，将每6个月测量以下因素： 月：传染病发病率、生物风险因素和社会风险因素（社会人口统计学和 社会心理学）。然后，我们将比较这些因素之间的儿童谁是高浓缩铀和胡。内 第二个目标，我们将测量24岁儿童的神经发育（认知、语言、运动和行为）， 使用儿童行为检查表和贝利婴幼儿发展量表， 第三版，我们的团队已经在肯尼亚进行了文化适应和内部验证。然后我们将 比较HEU和HUU儿童之间的神经发育结果， 数据，以确定组之间是否真的存在差异。最后，在第三个目标中，我们将使用 广义线性混合模型用于量化儿童神经发育多因素之间的关联 并创建用于24个月以下儿童的风险评估工具。这项拟议的研究意义重大，我们将 确定与儿童神经发育结果较差相关的相互关联的因素， 肯尼亚的高浓缩铀和高浓缩铀。由此产生的风险评估工具将允许临床提供者制定干预措施 对于神经发育不良的儿童来说，这项工作还将创造一个纵向 暴露于抗逆转录病毒治疗和艾滋病毒的儿童队列，可用于未来的研究监测。