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Table 3 Summary of studies reporting general cognition and specific domains and psychosocial aspects of C/ALHIV in SSA

From: Neurocognitive deficits and socioeconomic risk factors among children and adolescents living with HIV in sub-Saharan Africa: a systematic review

Author

Year & country

Sample (n)

age

setting

Study design

Neuropsychological tools

General Cognition and specific domains

Socioeconomic risk factors

Bangeda et al.

2006, Uganda

107, 28 HIV + , 42-, 37c

6–12 years

hospital

Cohort

K-ABC, WRAT-3

HIV + , no significant cognitive difference

No information about specific cognitive domains

showed significantly more evidence of acute malnutrition

Boivin et al.

2010a, Uganda

102 clinical group

6–12 years

Hospital

Cross sectional

KABC-II, TOVA, BOTS, HOME,

Children with HIV subtype A performed more poorly than those with HIV subtype D on all measures

Performed poorly on sequential processing (p = 0.01), simultaneous processing(p = 0.005), Learning (p = 0.03)

None

Boivin et al.

2010b, Uganda

60 PHIV

23 on HAART

6–16 years

Hospital

Cross sectional

Captain's Log CCRT, KABC-II, Cogstate, SES physical quality of home environment checklist

Sequential processing p = 0.01, simultaneous p = 0.02, learning, p = 0.05

None

Hoare et al.

2012, South Africa

12 HIV + , 12 HIV-

8–12 years

Clinics

Cross sectional

WASI-II

performed significantly worse than controls on all of the measures

deficits in visuo-spatial processing, visual memory and semantic fluency

None

Ruel et al.

2012, Uganda

93 HIV + , 106 HIV-

6–12 years

Hospital

Cross sectional

KABC-II

TOVA

BOT-2

HIV + children performed significantly worse than HIV-uninfected children

Deficits in sequential processing and planning/reasoning as compared with HIV-

HIV + with CD4 cell counts of > 350 cells/μL demonstrate significant cognitive and motor deficits

Higher HIV RNA level was associated with poor performance in simultaneous processing (coefficient, − 4.5; P = .015)

Impairment among those WHO stages 1 and 2 reported in sequential processing and planning

None

Boyede et al.

2013 a, Nigeria

(138)

69 HIV + 69 HIV -

6–15 years

Hospital

Cross sectional

RPM

RPM cognitive scores for HIV positive children are lower than those of HIV negative

No information about specific cognitive domains

younger age(p = 0.01), Low level of maternal

education (p = 0.001) and low SES was associated

with poor cognitive outcomes

Boyede et al.

2013b, Nigeria

69 HIV + 69 HIV-

6–15 years

Hospital

Cross sectional

RPM

Had significantly lower cognitive scores compared with HIV negative children

No information about specific cognitive domains

None

Boyede et al.

2013c, Nigeria

69 HIV + , 39 on HAART 30 not on HAART

6–15 years

Hospital

Cross sectional

RPM

RPM scores tended to be lower with worsening WHO clinical stage

No information about specific cognitive domains

None

Kandawasvika et al.

2015, Zimbabwe

n = 306 32 HIV infected, 121 exposed uninfected 153 unexposed uninfected

6–8 years

clinics

Cross sectional

MSCA

No difference in general cognitive function

Deficits in perceptual performance in HIV infected group

Unemployed caregivers, undernutrition, child orphanhood were associated with impaired

cognitive performance in univariate analysis

Boivin et al.

2016, Uganda

159

6–12 years

Hospital

Randomized Controlled Trial (Group 1 CCRT n = 53, Group 2 Limited CCRT n = 52, Group 3 Control n = 54)

Captain's Log CCRT, KABC-II, CogStateBruininks/

Oseretsky test; BRIEF, CBCL, TOVA

At baseline, performed poorly on simultaneous processing (p = .035), learning (p = .047), knowledge (p = .001), NVI (p = .001)

The CCRT group had significantly greater gains through 3 months of follow-up compared to passive controls on overall KABC-II mental processing index, planning, and knowledge

The limited CCRT group performed better than controls on learning

None

Iloh et al.

2017, Nigeria

200 (100 HIV + and 100 HIV-)

6–15 years

Hospital

Cross sectional

RPM

lower cognitive functioning was noted among HIV positive compared with HIV negative peers

No information about specific cognitive domains

all children with mother with no formal education performed below average. SES (p ¼ 0.028) and immunologic stage (0.015) had significant

negative effect on RPM scores of HIV-positive children

Brahmbhatt et al.

2017, Uganda

370, 204 HUU, 26 PHEU, 140 PHIV

7–14 years

Clinics

Cross sectional

KABC-II

No significant differences in the neurocognitive measures between PHIV and HUU

PHIV had an impairment in simultaneous processing, learning and knowledge skills compared with PHUU and PHEU at baseline

increases in both age standardized weight and

height resulted in significant improvement of sequential and simultaneous processing skills

Musindo et al.

2018, Kenya

90 HIV + 

8–15 years

Hospital

Cross sectional

KABC-II, HEADS_ED

60% scored below 2SD

High prevalence was seen in Simultaneous processing, planning and Nonverbal index

education and activities and peer support was associated with poor neurocognitive outcomes

Boivin et al.

2018

South Africa, Zimbabwe, Malawi, Uganda

611

246 HIV + , 183 HEU, 182 HUU

5–11

Clinics

observational multicentre longitudinal study

KABC-II

TOVA

BOT-2

BRIEF

SES

MICS4

HIV + children performed poorly than both HUU and HEU on the composite scores (mental processing index)

deficits in sequential processing (working memory) learning, delayed recall, planning, simultaneous, non-verbal index as compare to negative controls

Area of residence, height for age, paternal level

of education were associated with low cognitive

scores

Debeaudrap et al.

2018, Cameroon

338

127 HIV-infected, 101 HEU, 110 HUU

4–9 years

Hospital

Cross sectional

SDQ

KABC-II

HIV-infected children performed significantly worse than HUU children on MPI scores

HEU children also had significantly lower MPI, NVI, learning and planning scores than HUU children

Mother’s education and vital status, caregiver depression and anxiety scores and household

income

HIV-infected children had higher SDQ scores

than HUU children indicating that they

experienced more behavioural difficulties

Familiar et al.

2019, Zimbabwe, South Africa, Uganda and Malawi

611

183 HEU

182 HUU

246 HIV-I

5–11

Clinics

 

Hopkins Symptom Checklist (HSCL)

KABC-II

TOVA

BOT-2

BRIEF

MPI scores were significantly lower among HIV + children compared with HEU and HUU children

No information about specific cognitive domains

Caregiver depressive

symptomatology was not associated with other assessed KABC-II (MPI) scores

Boivin et al.

2020, South Africa, Zimbabwe, Malawi, Uganda

611

183 HEU

182 HUU

246 HIV-I

5–11

clinics

Observational multicentre longitudinal study

KABC-II

TOVA

BOT-2

BRIEF

The HIV + cohort performed significantly worse than the HEU and HUU cohorts for all KABC-II

Deficits in simultaneous processing, sequential processing, learning, planning and delayed recall as compared to negative controls

Higher SES index scores were predictive of

better KABC scores

  1. RPM Ravens Progressive Matrices, KABC-II Kaufman Assessment Battery for children- Second edition, WASI-II Wechsler Abbreviated Scale of Intelligence—Second Edition, MSCA- McCarthy Scales of Children `s Abilities, AWMA Automated Working Memory Assessment
  2. PHIV Perinatally HIV Infected, PHEU Perinatally HIV Exposed but Uninfected, HUU HIV Unexposed and Uninfected