The Lancet Child & Adolescent Health

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The Lancet Child & Adolescent Health Neurodevelopment of HIV-exposed uninfected children in South Africa: outcomes from an observational birth cohort study Catherine J Wedderburn, MBChB, Shunmay Yeung, PhD, Andrea M Rehman, PhD, Jacob A M Stadler, MBChB, Raymond T Nhapi, MSc, Whitney Barnett, MPH, Landon Myer, PhD, Diana M Gibb, MD, Heather J Zar, PhD, Dan J Stein, PhD, Kirsten A Donald, PhD The Lancet Child & Adolescent Health DOI: 10.1016/S2352-4642(19)30250-0 Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 1 Drakenstein Child Health Study profile BSID-III=Bayley Scales of Infant and Toddler Development, third edition. *Excluded from this analysis, but not from the Drankenstein Child Health Study follow-up. †209 (80%) of the 260 children assessed on BSID-III at 6 months were also assessed at 24 months (46 HIV-exposed uninfected and 163 HIV-unexposed). ‡No show because of violence, poor weather conditions, or seasonal work. The Lancet Child & Adolescent Health DOI: (10.1016/S2352-4642(19)30250-0) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 2 Directed acyclic graph We constructed a directed acyclic graph using DAGitty to examine for possible confounding in the relationship between HIV and ART exposure and child developmental performance on the Bayley Scales of Infant and Toddler Development, third edition, at 6 months and 24 months in the Drakenstein Child Health Study, using multiple sources.3,10–12 In this model, site acts as a proxy for home language and ethnicity. Maternal psychosocial factors include maternal depression, alcohol use, and smoking. Minimal sufficient adjustment sets for estimating the total effect of maternal HIV and ART exposure on child neurodevelopment include socioeconomic status (household income), maternal education, and maternal age. ART=antiretroviral therapy. The Lancet Child & Adolescent Health DOI: (10.1016/S2352-4642(19)30250-0) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions