1. Early childhood development among HIV exposed uninfected children
Nigel Rollins
Department of Maternal, Newborn, Child and Adolescent Health
World Health Organization
Geneva, Switzerland
IAS, 22 July 2018

2. Magnitude of the challenge and opportunity
Data Source: UNAIDS 2018

3. Early childhood development in children living with HIV
Delayed development among infected children has long been reported.
Microcephaly and impaired growth commonly noted
Issues are complex and more monitoring and research needed to inform and improve management
Cognitive delay frequently reported among HIV infected children
Complex social and health contexts
Need greater monitoring and research to understand the problem and to improve management

4. Development in HIV exposed uninfected children
Increasing awareness and reports of developmental delay in HIV exposed, uninfected children
Delays reported compared to the general population but …..
Development can be normal

5. Why HIV exposed, uninfected children are vulnerable to sub-optimal development
Potential mechanisms …
HIV exposure itself (but data not indicative of a stand-alone risk)
ART exposure in utero
Postnatal ARVs as prophylaxis
Maternal well-being and care practices
Non-breastfeeding: to prevent HIV transmission
Increased risk of exposure to opportunistic infections
Poverty, stress and undernutrition
HIV exposed children are vulnerable to developmental delay irrespective of their HIV status due to combined effect of risk factors like poverty, prenatal drug exposure, stress and chronic illness in family and malnutrition
But reports of these outcomes span 15+ years when different ARVs were implemented to improve the health of mothers and prevent transmission and breastfeeding was commonly avoided.
Data needed in the context of maternal ART for life and breastfeeding

6. HIV exposed, uninfected children are also susceptible to the same risk factors for impaired child development as the general population
Low birth weight
Stunting
Undernutrition
Poverty
Sub-optimal care practice
Responsive caregiving
Early learning opportunities
All that is provided through ……. Nurturing care

7. Where to now?
Health services have a major opportunity to contribute to early child development of a large and vulnerable population in SSA (historically, ECD has been seen as an education sector issue)
Maternal and child health services plus other sectors should orient around the nurturing care framework
Identify vulnerable children: LBW, stunted, HIV-infected, HIV exposed
Offer integrated care according to the mother and child’s vulnerability
HIV-specific or non-HIV vulnerabilities
HIV-specific care and non-HIV specific care
Research to understand HIV-specific risk factors in the context of ART for all.
We have talked about integration for the past decade. ECD for HEU is a prime example of where this is an absolute necessity

8. New paradigm, new target, ….. ?new metric
HIV prevention
HIV free survival
HIV free survival and development