Quality of Caregiving is Positively Associated With Neurodevelopment During the First Year of Life Among HIV-Exposed Uninfected Children in Uganda

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We sought to evaluate whether maternal characteristics and infant developmental milieu were predictive of early cognitive development in HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HU) infants in Uganda.


Longitudinal pregnancy study.


Ugandan women (n = 228) were enrolled into the Postnatal Nutrition and Psychosocial Health Outcomes study with a 2:1 HIV-uninfected: infected ratio. Maternal sociodemographic, perceived social support, and depressive symptomatology were assessed. Infant growth and neurocognitive development were assessed at 6 and 12 months of age using Mullen Scales of Early Learning (MSEL). Caldwell Home Observation for Home Environment was used to gauge caregiving quality. Linear mixed-effects models were built to examine the relationships between maternal and infant characteristics with infant MSEL scores by HIV exposure.


Two MSEL measures were available for 215 mother–child dyads: 140 infants (65%) were HIV-uninfected (HU), 57 (27%) were HIV-exposed uninfected (HEU) with mothers reporting antiretroviral therapy, and 18 (8%) were HEU with mothers not reporting antiretroviral therapy. HEU had lower MSEL Composite (β = −3.94, P = 0.03) and Gross Motor scores (β = −3.41, P = 0.01) than HU. Home Observation for Home Environment total score was positively associated with MSEL Composite (β = 0.81, P = 0.01), Receptive Language (β = 0.59, P = 0.001), and Expressive Language (β = 0.64, P = 0.01) scores.


HIV exposure is associated with lower infant cognitive development scores. Increasing maternal quality of caregiving may improve early cognitive development.

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