title: Psychosocial adjustment in perinatally human immunodeficiency virus infected or exposed children - a Retrospective Cohort Study.
abstract: To determine whether perinatal HIV infection and exposure adversely affected psychosocial adjustment (PA) between 6 and 18 years of life (i.e. during school-age and adolescence).
  
  
  
  We enrolled 58 perinatally HIV-infected, 56 HIV-exposed uninfected and 54 unexposed controls from Kampala, Uganda. Perinatal HIV status was determined by 18 months of age using a DNA-polymerase chain-reaction test and was confirmed via HIV rapid diagnostic test at psychosocial testing when the children were 6 to 18 years old. Five indicators of PA (depressive symptoms, distress, hopelessness, positive future orientation and esteem) were measured using validated, culturally adapted and translated instruments. Multivariable linear regression analyses estimated HIV-status-related percent differences (β) in PA indicators and corresponding 95% confidence intervals (CIs).
  
  
  
  During school-age and adolescence, positive outlook (β=-3.8, 95% CI: -7.2, -0.1) and self-esteem (β=-4.3, 95% CI: -6.7, -1.8) scores were significantly lower, whereas depressive (β=11.4, 95% CI: 3.3, 19.5) and distress (β=12.3, 95% CI: 5.9, 18.7) symptoms were elevated for perinatally HIV-infected, compared to unexposed controls and exposed uninfected children. Similarly, positive outlook (β=-4.3, 95% CI: -7.3, -1.2) and self-esteem were lower for exposed controls versus HIV-unexposed children. Hopelessness was similar by perinatal HIV status. Likewise, the distress and depressive symptom levels were comparable for HIV-exposed uninfected and HIV-unexposed children.
  
  
  
  Perinatal HIV infection predicted higher distress and depressive symptoms, while HIV-affected status (infection/exposure) predicted low self-esteem and diminished positive outlook in the long term. However, HIV-affected status had no impact on hopelessness, suggesting that psychosocial interventions as an integral component of HIV care for infected children or primary care exposed uninfected children may improve PA and quality of life in these vulnerable groups.
authors.affiliation: Directorate of Public Health and Environment, Kampala Capital City Authority, Kampala, Uganda.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Zalwango
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia.|Division of Health Protection, Office of HIV, Georgia Department of Public Health, Atlanta, Georgia.
authors.forename: Florence N
authors.initials: FN
authors.lastname: Kizza
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia.
authors.forename: Allan K
authors.initials: AK
authors.lastname: Nkwata
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia.|School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Sekandi
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia.
authors.forename: Robert
authors.initials: R
authors.lastname: Kakaire
authors.affiliation: School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Whalen
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia.|Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; amara.ezeamama@hc.msu.edu.
authors.forename: Amara E
authors.initials: AE
authors.lastname: Ezeamama
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D003863:Depression; D005195:Family Relations; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011788:Quality of Life; D012189:Retrospective Studies; D012917:Social Adjustment; D014454:Uganda
keywords: HIV; depressive symptoms; distress; positive outlook; psychosocial adjustment