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Browsing by Author "Vreeman, Rachel Christine"
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Item Interventions for Developmental Delays in Children Born to HIV-infected Mothers: A Systematic Review(Taylor & Francis, 2019-03) Song McHenry, Megan; Ian McAteer, Carole; Oyungu, Eren; Deathe, Andrew Roland; Vreeman, Rachel Christine; Pediatrics, School of MedicineChildren born to HIV-infected mothers have worse developmental outcomes compared to HIV-unexposed children. However, little is known about interventions to improve developmental outcomes in this population. This study systematically reviews the literature on interventions to improve development in children born to HIV-infected mothers. We systematically searched the following electronic bibliographic databases: Ovid MEDLINE, Embase, PsycINFO, Education Resources Information Center, and the Cochrane Database of Systematic Reviews. Studies were selected on the basis of defined inclusion criteria and excluded if antiretroviral medication was the only intervention. Titles, abstracts, and full texts were assessed by 2 independent reviewers. Data were collected on characteristics of the study design, intervention, and developmental outcomes measured. Risk of bias and strength of evidence were assessed on all included articles. Our search resulted in 11,218 records. After our initial review, 43 records were appraised in their entirety and 9 studies met all inclusion criteria. Six were performed in sub-Saharan Africa, while the remaining 3 were performed in the United States. Eight were randomized-controlled trials and one was a retrospective chart review. Four studies focused on caregiver-training, 2 studied massage therapy, and the remaining studies focused on maternal vitamin supplementation, video-based cognitive therapy, or center-based interventions. Massage therapy had the most consistent improvements in the domains measured, while caregiver training and cognitive therapy interventions had limited benefits. The center-based intervention showed no benefit. Only 3 studies had a low risk of bias, and 4 studies had good strength of evidence. Most studies found some benefit. However, these findings are limited by the quality of the study designs, small sample size, and heterogeneity of the interventions and assessments used to measure outcomes. There is a critical need for the creation of evidence-based interventions to promote development in this vulnerable population.Item A systematic review of measures of HIV/AIDS stigma in paediatric HIV-infected and HIV-affected populations(IAS, 2016) McAteer, Carole Ian; Truong, Nhan-Ai Thi; Aluoch, Josephine; Deathe, Andrew Roland; Nyandiko, Winstone M.; Marete, Irene; Vreeman, Rachel Christine; Department of Pediatrics, IU School of MedicineIntroduction: HIV-related stigma impacts the quality of life and care management of HIV-infected and HIV-affected individuals, but how we measure stigma and its impact on children and adolescents has less often been described. Methods: We conducted a systematic review of studies that measured HIV-related stigma with a quantitative tool in paediatric HIV-infected and HIV-affected populations. Results and discussion: Varying measures have been used to assess stigma in paediatric populations, with most studies utilizing the full or variant form of the HIV Stigma Scale that has been validated in adult populations and utilized with paediatric populations in Africa, Asia and the United States. Other common measures included the Perceived Public Stigma Against Children Affected by HIV, primarily utilized and validated in China. Few studies implored item validation techniques with the population of interest, although scales were used in a different cultural context from the origin of the scale. Conclusions: Many stigma measures have been used to assess HIV stigma in paediatric populations, globally, but few have implored methods for cultural adaptation and content validity.Item Validation of a Short Adherence Questionnaire for Children Living with HIV on Antiretroviral Therapy in Kenya(SAGE Publications, 2018-01-01) Vreeman, Rachel Christine; Scanlon, Michael Lawrence; Tu, Wanzhu; Slaven, James; Ayaya, Samuel; Nyandiko, Winstone; Pediatrics, School of MedicineBackground:There are few validated tools to measure adherence for children living with HIV. We identified questionnaire items for caregivers of Kenyan children aged <15 years living with HIV.Methods:Caregiver?child dyads were followed for 6 months. At monthly visits, the child?s HIV provider administered a 10-item questionnaire to the caregiver. Children were given electronic dose monitors (Medication Event Monitoring Systems [MEMS]). Correlation between questionnaire items and dichotomized MEMS adherence (≥90% doses taken versus <90%) was investigated using logistic regression models.Results:In 95 caregiver?child dyads, mean age of children (40% female) was 8.3 years. Items associated with higher odds of MEMS adherence in multivariable analysis included the father giving the child medication, being enrolled in a nutrition program, and the caregiver reporting no difficulties giving the child medication.Conclusion:Providers typically ask about missed doses, but asking about caregiver responsibilities and difficulties in giving the child medication may better detect suboptimal adherence.Item Validation of an HIV/AIDS Stigma Measure for Children Living with HIV and Their Families(SAGE Publications, 2019-01-01) Vreeman, Rachel Christine; Scanlon, Michael Lawrence; Tu, Wanzhu; Slaven, James; McAteer, Carole; Aluoch, Josephine; Ayaya, Samuel; Nyandiko, Winstone Mokaya; Biostatistics, School of Public HealthBackground: There are few validated tools to measure stigma, particularly among children living with HIV and their families. Methods: This study was nested within a larger study that followed 240 child–caregiver dyads (children aged 10-15 years) at 8 clinics in western Kenya. The stigma instrument was administered to all child–caregiver dyads at 2 time points 6 months apart. The primary end point was to construct validity assessed by comparison to criterion constructs using generalized estimating equation models. Results: Mean age of child participants was 12.3 years and 52% were female. Generally, caregivers reported experiencing higher levels of HIV stigma compared to their children. Children (9%) and caregivers (14%) reported that HIV stigma made them feel stressed, anxious, and depressed. Child and caregiver stigma items showed high construct validity by emotional and behavioral outcomes. Conclusions: The stigma instrument showed high validity when compared to emotional and behavioral outcomes.