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Lower academic performance among children with perinatal HIV exposure in Botswana
Kathleen M Powis1,2,3, Lesedi Lebanna4, Sara Schenkel1
1Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Children exposed to HIV but uninfected (HEU) showed lower academic performance in Botswana compared to HIV-unexposed uninfected (HUU) children. Socio-demographic factors influenced this academic disparity, necessitating further research for targeted interventions.
Area of Science:
- Pediatric Health
- Neurodevelopmental Studies
- Educational Psychology
Background:
- Children exposed to HIV but uninfected (HEU) have shown increased risks of suboptimal neurodevelopment compared to HIV-unexposed uninfected (HUU) children.
- However, academic performance in school-aged HEU children has not been previously investigated.
Purpose of the Study:
- To compare academic performance in primary school children based on HIV exposure status in Botswana.
- To identify factors associated with academic performance differences between HEU and HUU children.
Main Methods:
- The study analyzed academic performance in Mathematics, Science, English, and Setswana among 398 primary school children (7.1–14.6 years) in the Botswana FLOURISH study.
- Performance was compared between HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) children using logistic regression models.
- Lower academic performance was defined as a grade of 'C' or lower (≤60%).
Main Results:
- HIV-exposed uninfected (HEU) children were more likely to exhibit lower overall academic performance (unadjusted OR: 1.96) and lower scores in Mathematics, Science, and English compared to HUU children.
- This association was attenuated after adjusting for maternal education, caregiver income, breastfeeding, low birth weight, and child sex (aOR: 1.86).
- Caregivers of HEU children were older and had lower educational attainment.
Conclusions:
- Primary school academic performance was lower in HEU children compared to HUU children in this Botswana cohort.
- Biological and socio-demographic factors, such as child sex and maternal education, contribute to these academic differences.
- Further research is recommended to identify modifiable factors and develop interventions to mitigate the risk of poor academic performance in HEU children.
Introduction:
Studies 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.
Methods:
Academic 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.
Results:
Between 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]).
Conclusions:
In 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.
