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Maternal HIV does not affect resiliency among uninfected/HIV exposed South African children from birth to 5 years of age

Rotheram-Borus, Mary Janea; Christodoulou, Joana; Hayati Rezvan, Pantehaa; Comulada, W. Scotta; Gordon, Saraha; Skeen, Sarahb; Stewart, Jackieb; Almirol, Ellena; Tomlinson, Markb

doi: 10.1097/QAD.0000000000002176
Supplement Articles

Objective: Examine resiliency among a South African population cohort of children of mothers living with HIV (MLH) and mothers without HIV (MWOH) in low-income townships over the first 5 years of life.

Design: A cluster randomized controlled intervention trial evaluating child resiliency and the effects of home visiting in township neighborhoods from pregnancy through 5 years postbirth.

Methods: The population of pregnant women in 24 matched neighborhoods were recruited and randomized by neighborhood to a standard care condition (n = 594) or a paraprofessional home visiting intervention condition (n = 644). Mothers and children were assessed at 2 weeks, 6, 18, 36, and 60 months postbirth (92–84% follow-up; 10.2% mortality). Resilient children were identified based on consistently meeting global standards for growth, cognitive functioning, and behavior. Maternal HIV status (n = 354 MLH; n = 723 mothers without HIV MWOH), intervention condition, maternal risks, caretaking, sociodemographic characteristics, and neighborhood were examined as predictors of child resiliency over time using analysis of variance, chi-square analyses, and Fisher's exact tests, where appropriate.

Results: None of HIV-seropositive children (n = 17) were resilient; 19% of 345 HIV-exposed but uninfected children of MLH were resilient, a rate very similar to the 16% among MWOH. Resiliency was significantly associated with lower income, food security, not having a live-in partner, and the absence of maternal risk (i.e., not being depressed, using alcohol, or being a victim of intimate partner violence). Being randomized to a home visiting intervention, maternal breastfeeding for at least 3 months and attending a preschool crèche were also unrelated to resiliency. Although matched pairs of neighborhoods had similar rates of resilient children, resiliency varied significantly by neighborhood with rates ranging from 9.5 to 27%.

Conclusion: We set a new standard to define resiliency, as consistently recommended by theoreticians. Although seropositive children are not resilient, uninfected children of MLH are as resilient as their peers of MWOH. Typical protective factors (e.g., home visiting, breastfeeding, preschool) were unrelated to resiliency over the first 5 years of life.

Trial registration: registration #NCT00996528.

aDepartment of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, California, USA

bDepartment of Psychology, Stellenbosch University, Stellenbosch, South Africa.

Correspondence to Mary Jane Rotheram-Borus, Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA. E-mail:

Received 29 March, 2018

Revised 6 February, 2019

Accepted 7 February, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.