Children of a syndemic: co‐occurring and mutually reinforcing adverse child health exposures in a prospective cohort of HIV‐affected mother‐infant dyads in Cape Town, South Africa

Author:

le Roux Stanzi M.1,Abrams Elaine J.23,Zerbe Allison2,Phillips Tamsin K.1,Myer Landon1

Affiliation:

1. Division of Epidemiology & Biostatistics School of Public Health, University of Cape Town Cape Town South Africa

2. Mailman School of Public Health ICAP at Columbia University, Columbia University New York New York USA

3. Department of Pediatrics, Vagelos College of Physicians & Surgeons Columbia University New York New York USA

Abstract

AbstractIntroductionSeveral HIV‐related syndemics have been described among adults. We investigated syndemic vulnerability to hazardous drinking (HD), intimate partner violence (IPV) and household food insecurity (HFIS) in breastfed children born without HIV in urban South Africa. We compared those who were perinatally HIV exposed (CHEU) to those who were not (CHU), under conditions of universal maternal antiretroviral therapy (ART) and breastfeeding.MethodsA prospective cohort of pregnant women living with HIV (WLHIV), and without HIV, were enrolled and followed with their infants for 12 months postpartum (2013–2017). All WLHIV initiated antenatal efavirenz‐based ART. Measurements of growth (∼3 monthly), infectious cause hospitalisation, ambulatory childhood illness (2‐week recall) and neurodevelopment (BSID‐III, measured at ∼12 months’ age) were compared across bio‐social strata using generalised linear regression models, with interaction terms; maternal data included interview‐based measures for HD (AUDIT‐C), IPV (WHO VAW) and HFIS.ResultsAmong 872 breastfeeding mother‐infant pairs (n = 461 CHEU, n = 411 CHU), WLHIV (vs. HIV negative) reported more unemployment (279/461, 60% vs. 217/411, 53%; p = 0.02), incomplete secondary education (347/461, 75% vs. 227/411, 55%; p < 0.0001), HD (25%, 117/459 vs. 7%, 30/411; p < 0.0001) and IPV (22%, 101/457 vs. 8%, 32/411; p < 0.0001) at enrolment; and HFIS at 12 months (45%, 172/386 vs. 30%, 105/352; p > 0.0001). There were positive interactions between maternal HIV and other characteristics. Compared to food secure CHU, the mean difference (95% CI) in weight‐for‐age Z‐score (WAZ) was 0.06 (−0.14; 0.25) for food insecure CHU; −0.26 (−0.42; −0.10) for food secure CHEU; and −0.43 (−0.61; −0.25), for food insecure CHEU. Results were similar for underweight (WAZ < −2), infectious‐cause hospitalisation, cognitive and motor delay. HIV‐IPV interactions were evident for ambulatory diarrhoea and motor delay. There were HIV‐HD interactions for odds of underweight, stunting, cognitive and motor delay. Compared to HD‐unexposed CHU, the odds ratios (95% CI) of underweight were 2.31 (1.11; 4.82) for HD‐exposed CHU; 3.57 (0.84; 15.13) for HD‐unexposed CHEU and 6.01 (2.22; 16.22) for HD‐exposed CHEU.ConclusionsThese data suggest that maternal HIV‐related syndemics may partly drive excess CHEU health risks, highlighting an urgent need for holistic maternal and family care and support alongside ART to optimise the health of CHEU.

Funder

Elizabeth Glaser Pediatric AIDS Foundation

South African Medical Research Council

Office of AIDS Research

Publisher

Wiley

Subject

Infectious Diseases,Public Health, Environmental and Occupational Health

Reference44 articles.

1. UNAIDS. AIDSinfo. Global data on HIV epidemiology & response. [Cited 2022 Jul 15]https://aidsinfo.unaids.org/.

2. Estimates of the global population of children who are HIV-exposed and uninfected, 2000–18: a modelling study

3. Statistics South Africa. Mid‐year population estimates. 2022 [Cited 2022 Feb 3]https://www.statssa.gov.za/?p=15601.

4. Clinical outcomes of HIV-exposed, HIV-uninfected children in sub-Saharan Africa

5. HIV-exposed, uninfected infants: new global challenges in the era of paediatric HIV elimination

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