ArticleJournal of the International AIDS Society2023
Lower academic performance among children with perinatal HIV exposure in Botswana.
Article in Journal of the International AIDS Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 16 citations in OpenAlex.
- Evaluating Risk of Tuberculosis Infection and Disease Among Adolescents Who Are HIV-exposed Uninfected in Botswana.The Pediatric infectious disease journal · 2026Article
- Lower working memory and processing speed among children and youth exposed to HIV.AIDS (London, England) · 2026Article
- Review
- Brain ultrasound radiomics identify textural differences in basal ganglia and white matter between full term newborns HIV-exposed uninfected and HIV-unexposed in Botswana.Early human development · 2025Observational
- Intelligence and language outcomes in school-aged children who are HIV-exposed, uninfected: the role of sex, perinatal risk factors, and socioeconomic status.Frontiers in pediatrics · 2025Article
- CEST MRI detects antiretroviral drug toxicities in the developing mouse brain.Frontiers in pharmacology · 2025Article
- Care of the Child Perinatally Exposed to Human Immunodeficiency Virus.Clinics in perinatology · 2024Review
- Feasibility of Brain Ultrasound Performed by Nurses in the Evaluation of Newborns Who Are HIV Exposed in Utero and Uninfected: A Pilot Study in Botswana.Children (Basel, Switzerland) · 2024Article
- Association of in utero HIV exposure with child brain structure and language development: a South African birth cohort study.BMC medicine · 2024Article
- Language outcomes of preschool children who are HIV-exposed uninfected: An analysis of a South African cohort.PloS one · 2024Article
- Achieving equity for children and adolescents with perinatal HIV exposure: an urgent need for a paradigm shift.Journal of the International AIDS Society · 2023Article
- Longitudinal Implementation of a Neurodevelopmental Screening Program for Children Born to Mothers Living With HIV in Maternal-Child Clinics in Kenya: A Mixed Methods Study.Journal of the International Association of Providers of AIDS CareArticle
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Authors and funding
15 authors at 8 institutions in 3 countries.
Funding
Abstract
introductionStudies have reported a higher risk of suboptimal neurodevelopment among children who are HIV-exposed uninfected (HEU) compared to children HIV-unexposed uninfected (HUU). Actual academic performance among school-aged children by HIV exposure status has not been studied.
methodsAcademic performance in Mathematics, Science, English, Setswana and overall among children enrolled in the Botswana-based FLOURISH study who were attending public primary school and ranging in age from 7.1 to 14.6 years were compared by HIV exposure status using a Cochran-Mantel-Haenszel test. Lower academic performance was defined as a grade of "C" or lower (≤60%). Unadjusted and adjusted logistic regression models were fit to assess for an association between HIV exposure and lower academic performance.
resultsBetween April 2021 and December 2022, 398 children attending public primary school enrolled in the FLOURSH study, 307 (77%) were HEU. Median age was 9.4 years (IQR 8.9-10.2). Only 17.9% of children HEU were breastfeed versus 100% of children HUU. Among children HEU, 80.3% had foetal exposure to three-drug antiretroviral treatment, 18.7% to zidovudine only and 1.0% had no antiretroviral exposure. Caregivers of children HEU were older compared to caregivers of children HUU (median 42 vs. 36 years) and more likely to have no or primary education only (15.0% vs. 1.1%). In unadjusted analyses, children HEU were more likely to have lower overall academic performance compared to their children HUU (odds ratio [OR]: 1.96 [95% confidence interval (CI): 1.16, 3.30]), and lower performance in Mathematics, Science and English. The association was attenuated after adjustment for maternal education, caregiver income, breastfeeding, low birth weight and child sex (aOR: 1.86 [95% CI: 0.78, 4.43]).
conclusionsIn this Botswana-based cohort, primary school academic performance was lower among children HEU compared to children HUU. Biological and socio-demographic factors, including child sex, appear to contribute to this difference. Further research is needed to identify modifiable contributors, develop screening tools to identify the risk of poor academic performance and design interventions to mitigate risk.
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