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

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要艾滋病毒暴露但未感染的儿童（HEU）可能会有更糟糕的神经发育结果与他们的艾滋病毒无暴露和未感染（HUU）同龄人相比。但是，这种潜力的病因关联尚不清楚。越来越多的儿童暴露于艾滋病毒，占超过15％的儿童某些国家的儿童，迫切需要确定与贫困相关的循证风险因素神经发育以适当靶向干预措施。此应用程序的具体目标是：（1）：在HEU和HUU和HUU和定义与较差的神经发育结果相关的人，以及（2）造成风险评估工具可以预测哪些儿童的神经发育结果将更糟。中央假设是Heu和Huu的孩子将具有不同的神经发育结果。那我们可以使用危险因素来预测哪些儿童在2岁之前会有更严重的结果的风险。这开发此工具的基本原理是识别有较差神经发育结果的儿童允许有针对性的干预。在AIM 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AIM 2中，我们将比较24个月大的孩子之间的神经发育结果是HEU和那些在肯尼亚的Huu的人。在AIM 3中，我们将创建一个风险评估工具，以预测儿童有24个月大的神经发育结局的风险恶化。这项研究将利用现有的队列前期招募500名HEU的儿童和500名是Huu和纵向的儿童从出生到24个月大。在第一个目标中，将每6个测量以下因素月份：感染性发病率，生物危险因素和社会风险因素（社会人口统计学和社会心理）。然后，我们将比较Heu和Huu的孩子之间的这些因素。在第二个目的，我们将在24岁的儿童中衡量神经发育（认知，语言，运动和行为）使用儿童行为清单以及婴儿和蹒跚学步的开发的Bayley量表，几个月大，第三版，我们的团队对其进行了文化适应和内部验证，可在肯尼亚使用。然后我们会比较HEU和HUU的儿童之间的神经发育结果，提供了良好的动力数据以确定两组之间是否真正存在差异。最后，在第三个目标中，我们将使用广义线性混合建模，以量化儿童神经发育中多个因素之间的关联并创建一个风险评估工具，用于儿童<24个月。拟议的研究很重要，我们将确定与较差的神经发育结果相关的相互联系的因素肯尼亚的Heu和Huu。由此产生的风险评估工具将使临床提供者能够提出干预措施对于有较差神经发育结果的儿童。这项工作还将创造一个纵向暴露于抗逆转录病毒疗法和艾滋病毒的儿童队列，可以监测以后的研究。