REFINE

REFINE is a collaborative study funded by the National Institute of Health (NIH) and conducted at the Blantyre Malaria Project (BMP) research clinics in Ndirande and Bvumbwe (Malawi).

This project is a longitudinal study aimed at assessing the impact of HIV- and antiretroviral therapy- (ART) exposure in utero on child neurocognitive development during the first 5 years of life. Every year, over 1.5 million children who are HIV-exposed but uninfected (HEU) are born in sub-Saharan Africa. Although vertical transmission of HIV is becoming rarer with improved access to ART, infant exposure in utero to HIV without infection is becoming more common. Emerging data suggest that CHEU are at a higher risk of neurocognitive delay compared to children who are HIV unexposed and uninfected (HUU).

The extend of this delay and contribution of environmental factors remains poorly characterized. Mother-infant pairs from an ongoing study will be offered enrolment in this long-term follow up study. We expect to enrol 210 mother-infant pairs equally divided in 3 groups: 1) infants born to women diagnosed with HIV infection at the first antenatal visit after 20 weeks of gestation;2) infants born to women on ART with undetectable viral loads before conception; and 3) HIV unexposed infants born to HIV uninfected mothers. The children will undergo multiple neurocognitive assessments at 2, 3.5 and 5 years of age. In addition, we will assess maternal mental and physical health, maternal-child interactions, home environment, general demographics, and stigma. By the end of the project, we expect to provide further insights into the impact of earlier versus late ART initiation on children’s neurocognitive development. Ultimately, this study will deliver essential information to inform the development of effective interventions to improve the lives of HEU children.

Neurocognitive assessment room at Ndirande Health Centre