Background

When caregivers live in remote settings characterised by extreme poverty, poor access to health services, and high rates of HIV/AIDS, their caregiving ability and children's development might be compromised. We aimed to test the effectiveness of a community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho.

Methods

We implemented a matched cluster-randomised, controlled trial in the Mokhotlong district in northeastern Lesotho with 34 community clusters randomly assigned to intervention or wait-list control groups within a pair. Eligible clusters were villages with non-governmental organisation partner presence and an active preschool. Participants were caregiver–child dyads, where the child was 12–60 months old at baseline. The intervention consisted of eight group sessions delivered at informal preschools to all children in each village. Mobile health events were hosted for all intervention (n=17) and control (n=17) clusters, offering HIV testing and other health services to all community members. Primary outcomes were caregiver-reported child HIV testing, child language development, and child attention. Assessments were done at baseline, immediately post-intervention (3 months post-baseline), and 12 months post-intervention. We assessed child language by means of one caregiver-report measure (MacArthur-Bates Communicative Development Inventory [CDI]) and used two observational assessments of receptive language (the Mullen Scales of Early Learning receptive language subscale, and the Peabody Picture Vocabulary Test 4th edn). Child attention was assessed by means of the Early Childhood Vigilance Task. Assessors were masked to group assignment. Analysis was by intention to treat. This trial was registered with ISRCTN.com, ISRCTN16654287 and is completed.

Findings

Between Aug 8, 2015, and Dec 10, 2017, 1040 children (531 intervention; 509 control) and their caregivers were enrolled in 34 clusters (17 intervention; 17 control). Compared with controls, the intervention group reported significantly higher child HIV testing at the 12-month follow-up (relative risk [RR] 1·46, 95% CI 1·29 to 1·65, p<0·0001), but not immediately post-intervention. The intervention group showed significantly higher child receptive language on the caregiver report (CDI) at immediate (effect size 3·79, 95% CI 0·78 to 6·79, p=0·028) but not at 12-month follow-up (effect size 2·96, 95% CI −0·10 to 5·98, p=0·056). There were no significant group differences for the direct assessments of receptive language. Child expressive language and child attention did not differ significantly between groups.

Interpretation

Integrated child health and parenting interventions, delivered by trained and supervised lay health workers, can improve both child HIV testing and child development.

Funding

United States Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR).

中文翻译：

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以社区为基础的儿童健康和育儿干预措施，以改善莱索托农村地区儿童艾滋病毒检测、健康和发展（晨星）：整群随机对照试验

背景

当护理人员生活在极端贫困、医疗服务获取困难以及艾滋病毒/艾滋病高发率的偏远地区时，他们的护理能力和儿童的发展可能会受到损害。我们的目的是测试基于社区的儿童健康和育儿干预措施的有效性，以改善莱索托农村地区儿童艾滋病毒检测、健康和发展。

方法

我们在莱索托东北部的 Mokhotlong 地区实施了一项匹配的整群随机对照试验，将 34 个社区集群随机分配到一对干预组或等候名单对照组中。符合条件的集群是拥有非政府组织合作伙伴且拥有活跃幼儿园的村庄。参与者是看护者与孩子的二人组，孩子的基线年龄为 12-60 个月。干预措施包括在非正式幼儿园为每个村庄的所有儿童举办八次小组课程。为所有干预组（n=17）和控制组（n=17）举办了流动健康活动，为所有社区成员提供艾滋病毒检测和其他健康服务。主要结果是看护者报告的儿童艾滋病毒检测、儿童语言发展和儿童注意力。在基线、干预后立即（基线后 3 个月）和干预后 12 个月进行评估。我们通过一项看护者报告测量（麦克阿瑟-贝茨交际发展量表 [CDI]）来评估儿童语言，并使用两项接受性语言的观察性评估（早期学习接受性语言子量表的马伦量表和皮博迪图片词汇测试第四版） ）。儿童注意力通过幼儿警惕任务进行评估。评估者不知道小组作业。分析是按意向治疗进行的。该试验已在 ISRCTN.com 注册（ISRCTN16654287）并已完成。

发现

2015年8月8日至2017年12月10日期间，1040名儿童（531名干预儿童；509名对照儿童）及其照顾者被纳入34个组（17名干预儿童；17名对照儿童）。与对照组相比，干预组在 12 个月的随访中报告儿童 HIV 检测显着较高（相对风险 [RR] 1·46，95% CI 1·29 至 1·65，p<0·0001），但不是在干预后立即进行。干预组立即在照料者报告 (CDI) 上显示儿童接受性语言显着较高（效果大小 3·79，95% CI 0·78 至 6·79，p=0·028），但在 12 个月的随访中情况并非如此。向上（效应大小 2·96，95% CI -0·10 至 5·98，p=0·056）。接受语言的直接评估没有显着的群体差异。儿童表达语言和儿童注意力在各组之间没有显着差异。

解释

由经过培训和监督的非专业卫生工作者提供的综合儿童健康和育儿干预措施可以改善儿童艾滋病毒检测和儿童发展。

资金

美国国际开发署 (USAID) 和总统艾滋病紧急救援计划 (PEPFAR)。