Attention Test Improvements from a Cluster Randomized Controlled Trial of Caregiver Training for HIV-Exposed/Uninfected Ugandan Preschool Children

Abstract

Objective: To report vigilance attention outcomes from a cluster randomized controlled trial of early childhood development caregiver training for perinatally HIV-exposed/uninfected preschool-age children in rural Uganda. The Early Childhood Vigilance Test (ECVT) provides a webcam recording of proportion of time a child views an animation periodically moving across a computer screen.

Study design: Sixty mothers/caregivers received biweekly year-long training sessions of the Mediational Intervention for Sensitizing Caregivers (MISC), and 59 mothers received biweekly training about nutrition, hygiene, and health care. Children were tested for attention at baseline, 6 months, and 12 months with the ECVT, in terms of proportion of time spent viewing a 6-minute animation of animals greeting the child and moving across the computer monitor screen. Time viewing the animation were scored by trained observers using ProCoder program for webcam scoring of proportion of time the child faced the animation. Mixed-effects modeling was used to compare ECVT outcomes for the 2 intervention groups.

Results: Unadjusted and adjusted (for age, sex, height, and ECVT at baseline) group differences on ECVT significantly favored the MISC arm at 6 months (P = .03; 95% CI (0.01, 0.11), effect size = 0.46) but not at 12 months. Both groups made significant gains in sustained attention across the year-long intervention (P = .021) with no significant interaction effects between time and treatment arms or sex.

Conclusions: Caregiver early childhood development training enhanced attention in at-risk Ugandan children, which can be foundational to improved working memory and learning, and perhaps related to previous language benefits reported for this cohort.

Trial registration: Clinicaltrials.gov: NCT00889395.

Keywords: Africa; HIV exposed but uninfected; attention; early childhood development; mediational intervention to sensitize caregivers (MISC); nutrition; webcam scoring.

Copyright © 2021 Elsevier Inc. All rights reserved.

Figures

Figure 1:. Participant Flow Chart for Tororo R34 HEU Cohort (Baseline to 12 months post enrollment)

Consort diagram from the cluster randomized controlled trial for children in Tororo Uganda born to mothers with confirmed HIV infection but who themselves were confirmed uninfected (HIV-exposed/uninfected). These were based on a sampling pool of 200 children who eligible at 2 years of age after completing a study on the “Interactions between HIV and malaria in African children” conducted by a University of California – San Francisco (UCSF), Makerere University, Center for Disease Control (CDC) collaboration entitled the “Tororo Child Cohort (TCC) study.