Admin Sup FACET: Family Dynamics and Child Neurodevelopment in Botswana

在撒哈拉以南非洲(SSA)，近1600万未感染艾滋病毒的儿童中90%是SSA的家园 (Chu)。这一人群的神经发育迟缓风险已被证明比 他们没有接触过艾滋病毒的同龄人。世界卫生组织和联合国儿童基金会倡导使用养育护理 框架，包括保健的五个方面--保健、营养、反应迅速的照料、免受威胁的安全和 学习机会--这一框架在全面实施时可优化儿童的神经发展。 鉴于家庭和照顾者是儿童养育护理的主要来源，探索 家庭结构、家庭环境和儿童神经发育之间的联系，特别是在 受艾滋病毒影响的家庭。在艾滋病毒高流行的博茨瓦纳，每四名15岁以下儿童中就有一名 只有不到10%的育儿夫妇正式结婚。考虑到养育护理 框架从未在博茨瓦纳以编程方式实现，照料结构也没有 描述得很好，理解在低结婚率和高艾滋病毒流行率这一独特背景下的照料 CHU与发育结果的关系对公共卫生具有至关重要的意义。这个 拟议的方面研究(博茨瓦纳的家庭动力学和儿童神经发展)将利用正在进行的 FORMISH研究中的出生队列(跟踪纵向结果以了解、报告、干预 和未感染艾滋病毒的婴幼儿、儿童和青少年的持续健康；R33 HD103099； 首席调查人员：鲍维斯、乔、马克赫马)目前招收多达300名孕妇，其中一半是 艾滋病毒携带者及其婴儿：a)(目标1)描述家庭构成和家庭模式 照料的动力，以及抚养性照料在促进儿童神经健康发育中的作用 在博茨瓦纳使用焦点小组讨论形式；和b)采用混合方法设计(目标2)，评估 儿童HIV暴露状况、照顾者关系因素与儿童神经发育的关系。 Caregier报告了早期发展指数(CREDI)，这是一种父母报告的评估工具，已经 经验证可在26个国家使用，其中包括博茨瓦纳在内的17个低收入和中等收入国家将 当孩子满六个月时，给参与的母亲注射。同时， 将从参加第二轮焦点小组讨论的多达30名母亲那里收集定性数据 探索他们与伴侣的关系、父亲在照料中的参与、家庭环境 因素(例如，粮食不安全、亲密伴侣暴力)和儿童气质可能会影响他们的照料。 将使用收敛的并行三角测量来联合解释定量和定性研究 调查结果。迫切需要研究来评估胎儿感染艾滋病毒和家庭结构的综合影响。 关于儿童神经发育的研究。

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.