Browsing by Author "Sikorskii, Alla"

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    Caregiver socioemotional health as a determinant of child well-being in school-aged and adolescent Ugandan children with and without perinatal HIV exposure
    (John Wiley & Sons Ltd, 2019) Webster, Kyle; Bruyn, Miko; Zalwango, Sarah; Sikorskii, Alla; Barkin, Jennifer; Familiar-Lopez, Itziar; Musoke, Philippa; Giordani, Bruno; Boivin, Michael; Ezeamama, Amara E.
    Caregiver socio-emotional attributes are major determinants of child well-being. This investigation in vulnerable school-aged Ugandan children estimates relationships between children’s well-being and their caregiver’s anxiety, depression and social support. methods Perinatally HIV-infected, HIV-exposed uninfected and HIV-unexposed Ugandan children and their caregivers were enrolled. Perinatal HIV status was determined by 18 months of age using DNA-polymerase chain-reaction test; status was confirmed via HIV rapid diagnostic test when children were 6–18 years old. Five indicators of child well-being (distress, hopelessness, positive future orientation, esteem and quality of life (QOL)) and caregivers’ socioemotional status (depressive symptoms, anxiety and social support) were measured using validated, culturally adapted and translated instruments. Categories based on tertiles of each caregiver psychosocial indicator were defined. Linear regression analyses estimated percent differences (b) and corresponding 95% confidence intervals (CI) for child well-being in relation to caregiver’s psychosocial status results As per tertile increment, caregiver anxiety was associated with 2.7% higher distress (95% CI:0.2%, 5.3%) and lower self esteem/QOL (b = 1.3%/ 2.6%; 95%CI: 5.0%,-0.2%) in their children. Child distress/hopelessness increased (b = 3.3%/7.6%; 95%CI:0.4%, 14.7%) and self-esteem/QOL decreased 2.3% (b = 2.3%/ 4.4%; 95%CI: 7.2%, 1.3%) as per tertile increment in caregiver depression. Higher caregiver social support was associated with lower distress and higher positive outlook (b = 3%; 95%CI:1.4%, 4.5%) in their children. HIV-infected/exposed children had most caregiver depression-related QOL deficit (b = 5.2%/ 6.8%; 95%CI: 12.4%, 0.2%) and HIV-unexposed children had most caregiver social support-related enhancements in positive outlook (b=4.5%; 95%CI:1.9%, 7.1%). conclusions Caregiver anxiety, depressive symptoms and low social support were associated with worse well-being in school-aged and adolescent children. Improvement of caregiver mental health and strengthening caregiver social support systems may be a viable strategy for improving well-being of vulnerable children and adolescents in this setting.
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    Caregivers’ Depressive Symptoms And Parent-Report Of Child Executive Function Among Young Children In Uganda
    (Learning and individual differences, 2016) Familiar, Itziar; Nakasujja, Noeline; Bass, Judith; Sikorskii, Alla; Murray, Sarah; Escudero, Horacio Ruisenor; Bangirana, Paul; Opoka, Robert; Boivina, Michael J.
    Maternal mental health (particularly depression) may influence how child behavior report. Few research has focused on sub-Saharan countries where pediatric HIV concentrates and impacts child neuropsychological development and caregiver mental health. We investigated the associations between caregivers' depressive symptoms and neuropsychological outcomes in HIV-infected (n=118) and HIV-exposed (n=164) Ugandan children aged 2–5years. We compared performance-based tests of development (Mullen Scales of Early Learning, Color Object Association Test), to a caregiver report of executive function (Behavior Rating Inventory of Executive Function, BRIEF). Caregivers were assessed with Hopkins Symptom Checklist-25 depression subscale. The associations between all BRIEF indices and caregiver's depression symptoms were differential according to child's HIV status. Caregivers with greater depressive symptoms reported their HIV-infected children as having more behavioral problems related to executive functioning. The assessment of behavior of HIV-infected children should incorporate a variety of sources of information and screening of caregiver mental health.
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    Computerized Cognitive Rehabilitation Training for Ugandan Seniors Living with HIV: A Validation Study
    (Journal of Clinical Medicine, 2020) Ezeamama, Amara E.; Sikorskii, Alla; Sankar, Parvathy R.; Nakasujja, Noeline; Ssonko, Michael; Kaminski, Norbert E.; Guwatudde, David; Boivin, Michael J.; Giordani, Bruno
    The feasibility, acceptability and preliminary efficacy of computerized cognitive rehabilitation therapy (CCRT) for mitigating neurocognitive decline was evaluated in African adults 50 years old. Eighty-one Ugandans with (n = 40) and without (n = 41) chronic human immunodeficiency viruses (HIV) were allocated CCRT—i.e., 20–45-min cognitive training sessions with culturally adapted video games delivered via Captain’s Log Software, or standard of care (SOC). Pre and post (i.e., 8-weeks later) intervention performance based neurocognitive tests, quality of life (QOL) and frailty related phenotype (FRP) were determined in all respondents. Multivariable linear regression estimated CCRT- vs. SOC-related di erences ( ) in neurocognitive batteries, QOL and FRP. E ect sizes (ES) for estimated were calculated. CCRT protocol was completed by 92.8% of persons allocated to it. Regardless of HIV status, CCRT was associated with higher performance in learning tests than SOC—interference list ( = 1.00, 95%CI: (0.02, 1.98); ES = 0.43) and delayed recall ( = 1.04, 95%CI: (0.06, 2.02); ES = 0.47). CCRT e ect on verbal fluency was clinically important (ES = 0.38), but statistical significance was not reached ( = 1.25, 95%CI: (􀀀0.09, 2.58)). Among HIV-positive adults, clinically important post-CCRT improvements were noted for immediate recall (ES = 0.69), working memory (ES = 0.51), verbal fluency (ES = 0.51), and timed gait (ES = 􀀀0.44) tasks. Among HIV-negative adults, CCRT resulted in moderate post-intervention improvement in learning tests (ES = 0.45) and large decline in FRP (ES = 􀀀0.71), without a positive e ect on simple attention and visuomotor coordination tasks. CCRT intervention is feasible among older Ugandan adults with potential benefit for learning and verbal fluency tests regardless of HIV status and lowering FRP in HIV-negative older adults.
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    Evolution of Anemia Types During Antiretroviral Therapy—Implications for Treatment Outcomes and Quality of Life Among HIV-Infected Adults
    (Nutrients, 2019) Ezeamama, Amara E.; Sikorskii, Alla; Bajwa, Ramanpreet K.; Tuke, Robert; Kyeyune, Rachel B.; Fenton, Jenifer I.; Guwatudde, David; Fawzi, WafaieW.
    This study examined whether the type of anemia in persons living with HIV/AIDS (PLWHA) changed from the beginning of highly antiretroviral therapy (HAART) and had implications for treatment outcomes and quality of life (QOL). If present, the anemia-type was defined as microcytic, macrocytic or anemia of chronic disease (ACD) at study months 0, 6, 12, and 18. Multinomial logistic regression quantified sociodemographic and HIV-treatment factors associated with incident microcytic anemia or ACD over 18 months. Repeated measures linear regression models estimated the anemia-type associated change in the CD4 cell-count, QOL, body mass index (BMI) and frailty over 18 months. Cox proportional hazard models estimated associations between anemia-type and time to (a) gain at least 100 CD4 cells/L and (b) hospitalization/death. Analyses were implemented in Statistical Analysis Software (v.9.4) from which odds ratios (ORs) mean differences ( ) and corresponding 95% confidence intervals (CI) were estimated. At enrollment, ACD, macrocytic and microcytic anemia was present in 36.8% (n = 147), 11.3% (n = 45) and 9.5% (n = 38), respectively with 42% (n = 170) anemia-free. By the study end, only 23% (n = 115) were without anemia. Among the 251 with anemia at the study end, 53.3% (n = 195) had macrocytic anemia, 12.8% (n = 47) had ACD and 2.5% (n = 9) had microcytic anemia. Incident macrocytic anemia was positively associated with baseline hyperferritinemia (OR = 1.85, 95%CI: 1.03–3.32), inversely associated with wealth (OR = 0.87, 95%CI: 0.67–1.03) and inversely associated with efavirenz-containing HAART (OR = 0.42, 95%CI: 0.21–0.85). ACD incidence decreased by 53% (95%CI: 0.27–0.79) per 100 cells/L increase in baseline CD4-cell count and decreased by 90% (95%CI: 0.01,0.87) among adults treated with nevirapine-containing HAART. ACD was associated with a lower BMI at months 6 ( = 􀀀0.33, 95% CI: 􀀀0.64, 􀀀0.01) and 12 ( = 􀀀0.41, 95%CI: 􀀀0.73, 􀀀0.09), with lower QOL ( = 􀀀3.2, 95%CI: 􀀀5.94, 􀀀0.53) at month 12 and with elevated frailty ( = 1.2; 95%CI: 0.46, 1.86) at month 12. Macrocytic anemia did not predict a post-enrollment change in CD4, BMI or QOL during follow-up. However, the time to gain 100 CD4 cells/L was 43% slower (p < 0.05) and the frailty was higher at month 12 for PLWHA with the baseline or sustained macrocytic vs. no anemia. A substantial decline in ACD and microcytic anemia occurred in tandem with large increase in the macrocytic anemia over 18 months on HAART. Interventions to mitigate all anemia—particularly ACD, is expected to improve the immune recovery rate, lower frailty, and enhanced QOL.
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    In utero/peripartum antiretroviral therapy exposure and mental health outcomes at 8–18 years old: A longitudinal comparative study of children with perinatally acquired HIV, children perinatally HIV exposed but uninfected, and children unexposed uninfected from Uganda
    (Wiley Subscription Services, Inc, 2024-04) Coventry, Audrey; Sikorskii, Alla; Zalwango, Sarah K.; Familiar‐Lopez, Itziar; Cardino, Vanessa N.; Giordani, Bruno; Ezeamama, Amara E.
    Abstract In utero/peripartum antiretroviral therapy (IPA) exposure type was examined in relationship to mental health symptoms among 577 children with perinatally acquired HIV (CPHIV), children perinatally HIV exposed but uninfected (CHEU), and children HIV unexposed uninfected (CHUU). IPA exposure was categorized for CPHIV and CHEU as none, single-dose nevirapine with or without zidovudine (sdNVP±AZT), sdNVP+AZT+lamivudine (3TC), or combination antiretroviral therapy (cART). Anxiety and depressive symptoms were reported at baseline, 6-, and 12-month follow-up per behavioral assessment system for children. Multivariable linear mixed models were used to estimate differences (b) with 95% confidence intervals (95% CI) for IPA exposure types versus CHEU without IPA exposure. Depressive and anxiety symptoms were lower in CHUU relative to CHEU and CPHIV but did not differ between CPHIV and CHEU. CHEU with sdNVP±AZT exposure had greater anxiety (b = 0.51, 95% CI: [0.06, 0.96]) and depressive symptoms (b = 0.48, 95% CI: [0.07, 0.89]) than CHEU without IPA exposure. CHEU with sdNVP+AZT+3TC exposure had higher anxiety (b = 0.0.45, 95% CI: [0.03, 0.86]) and depressive symptoms (b = 0.72, 95% CI: [0.27, 1.17]) versus CHEU without IPA exposure. Depressive and anxiety symptoms were not different for CHEU and CPHIV exposed to cART (b = 0.12-0.60, 95% CI: [-0.41, 1.30]) and CHEU and CHUU (b = -0.04 to 0.08, 95% CI: [-0.24, 0.29]) without IPA exposure. Among CHEU, peripartum sdNVP±AZT and sdNVP+AZT+3TC but not cART compared to no IPA exposure was associated with clinically important elevations in anxiety and depressive symptoms. Monitoring of mental health trajectory of HIV-affected children considering IPA is needed to inform mental health interventions. Patient Contribution: Caregivers and their dependents provided consent for participation and collaborated with study team to identify mutually convenient times for protocol implementation.
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    Psychosocial Adjustment in Ugandan Children: Coping With Human Immunodeficiency Virus Exposure, Lifetime Adversity, and Importance of Social Support
    (New Directions for Child and Adolescent Development, 2020) Tuke, Robert; Sikorskii, Alla; Zalwango, Sarah K.; Webster, Kyle D.; Ismail, Alexander; Pobee, Ruth A.; Barkin, Jennifer L.; Boivin, Michael J.; Giordani, Bruno; Ezeamama, Amara E.
    Cumulative lifetime adversity and social support were investigated as determinants of psychosocial adjustment (esteem, distress, hopefulness, positive outlook/ future aspirations, and sense of purpose) over 12months in 6–10-years-old HIV-infected, HIV-exposed uninfected and HIV-unexposed uninfected children from Uganda. Each determinant and psychosocial adjustment indicator was self-reported using standardized questionnaires administered at baseline, 6, and 12 months. Linear mixed effects models were used to relate time-varying lifetime adversity and social support to psychosocial adjustment over 12 months. Regardless of HIV status, higher adversity predicted lower esteem (coefficient b = −2.98, 95% confidence interval (CI): [−4.62, −1.35]) and increased distress (b =3.96, 95% CI: [1.29, 6.62]) but was not associated with hopefulness, positive outlook or sense of purpose. Low social support predicted higher distress (b =9.05, 95% CI: [7.36, 10.73]), lower positive outlook
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    Serum n-6 Fatty Acids are Positively Associated with Growth in 6-to-10-Year Old Ugandan Children Regardless of HIV Status—A Cross-Sectional Study
    (Licensee MDPI, 2019) Jain, Raghav; Ezeamama, Amara; Sikorskii, Alla; Yakah, William; Zalwango, Sarah; Musoke, Philippa; Boivin, Michael; Fenton, Jenifer
    Fatty acids (FAs) are crucial in child growth and development. In Uganda, antiretroviral therapy (ART) has drastically reduced perinatal human immunodeficiency virus (HIV) infection of infants, however, the interplay of FAs, ART, and HIV in relation to child growth is not well understood. To investigate this, serum was collected from 240 children between 6–10 years old in Uganda and analyzed for FAs using gas-chromatography mass-spectrometry. HIV status and anthropometric measurements were taken, and relationships with FAs were assessed. No significant differences in growth parameters or serum FAs were found between HIV uninfected children with and without exposure to ART. HIV positive children had significantly lower height-for-age-z-scores (HAZ) than uninfected children (p < 0.001). HIV-positive children had higher arachidonic acid than uninfected children (p = 0.003). Total omega-6 FAs were significantly associated with HAZ regardless of HIV status (p = 0.035). Mean total omega-3 FAs (2.90%) were low in this population compared to other cohorts in Africa. These results provide reference serum FA values for 6–10-year-old children in Uganda and may be used to inform lipid supplementation programs to promote child growth. Future studies should investigate the relationships between child growth trajectories in relation to HIV status and serum FAs.
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    Serum n-6 Fatty Acids are Positively Associated with Growth in 6-to-10-Year Old Ugandan Children Regardless of HIV Status—A Cross-Sectional Study
    (Nutrients, 2019) Jain, Raghav; Ezeamama, Amara E.; Sikorskii, Alla; Yakah, William; Zalwango, Sarah; Musoke, Philippa; Boivin, Michael J.; Fenton, Jenifer I.
    Fatty acids (FAs) are crucial in child growth and development. In Uganda, antiretroviral therapy (ART) has drastically reduced perinatal human immunodeficiency virus (HIV) infection of infants, however, the interplay of FAs, ART, and HIV in relation to child growth is not well understood. To investigate this, serum was collected from 240 children between 6–10 years old in Uganda and analyzed for FAs using gas-chromatography mass-spectrometry. HIV status and anthropometric measurements were taken, and relationships with FAs were assessed. No significant differences in growth parameters or serum FAs were found between HIV uninfected children with and without exposure to ART. HIV positive children had significantly lower height-for-age-z-scores (HAZ) than uninfected children (p < 0.001). HIV-positive children had higher arachidonic acid than uninfected children (p = 0.003). Total omega-6 FAs were significantly associated with HAZ regardless of HIV status (p = 0.035). Mean total omega-3 FAs (2.90%) were low in this population compared to other cohorts in Africa. These results provide reference serum FA values for 6–10-year-old children in Uganda and may be used to inform lipid supplementation programs to promote child growth. Future studies should investigate the relationships between child growth trajectories in relation to HIV status and serum FAs. View Full-Text
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    Serum Vitamin D is Di erentially Associated with Socioemotional Adjustment in Early School-Aged Ugandan Children According to Perinatal HIV Status and In Utero/Peripartum Antiretroviral Exposure History
    (Nutrients, 2019) Yakah, William; Fenton, Jenifer I.; Sikorskii, Alla; Zalwango, Sarah K.; Tuke, Robert; Musoke, Philippa; Boivin, Michael J.; Giordani, Bruno; Ezeamama, Amara E.
    An impact of vitamin D in neurocognitive function has been theorized but it remains unknown whether vitamin-D insufficiency (VDI) is associated with worse socio-emotional adjustment (SEA) in vulnerable early school-aged children. This study examines the thesis that deficits in SEA are related to VDI using longitudinal data from 254 children that are perinatally HIV-infected (PHIV), exposed-uninfected (HEU), or unexposed-uninfected (HUU). In utero/peripartum antiretroviral (IPA) exposure was established per medical record documentation of biological mother’s ART regimen in pregnancy. Four caregiver-reported age- and sex-standardized measures of SEA were obtained at months 0, 6, and 12 for dependent children aged 6–10 years: externalizing problems (EPC), internalizing problems (IPC), behavioral symptoms index (BSI), and adaptive skills index (ASI). VDI was highly prevalent (74%, n = 188), and its association with change in SEA measures over 12 months varied by HIV-status (VDI*HIV, all p-values < 0.03). There was further variation in relationship of vitamin-D to SEA by IPA among PHIV (for ASI, BSI, and EPC, vitamin-D*IPA, p-value ≤ 0.01) and HEU (for BSI and EPC, vitamin-D*IPA, p-value ≤ 0.04). Among HUU, BSI (β = −0.32, 95% CI: −0.50, −0.13), IPC (β = −0.28, 95% CI: −0.47, −0.09), and EPC (β = −0.20, 95% CI: −0.37, −0.02) all declined moderately per quartile increment in VD. Among PHIV, on the one hand higher vitamin D predicted ASI gains (moderate vs. low VD, β = 0.52, p = 0.002), but this protective association was absent for BSI, EPC, and IPC (β = 0.36–0.77, p < 0.05). In absence of IPA-exposure, increasing vitamin-D predicted declines in BSI and EPC (moderate vs. low Vitamin D, β = −0.56 to −0.71, p ≤ 0.02) among HEU. However, given IPA exposure among HEU, higher VDI predicted moderate elevation in BSI (β = 0.39, 95% CI: 0.00, 0.78) and IPC (β = 0.48, 95% CI: 0.05, 0.92). Interaction between VD and IPA exposure for SEA outcomes among HEU and PHIV children warrants further investigation. The vitamin-D associated SEA improvement among HUU and HEU without IPA exposure suggests vitamin-D supplementation may remediate behavioral and adaptive deficits in this groups. View Full-Text
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    Toxic Stress and Quality of Life in Early School-Aged Ugandan Children With and Without Perinatal Human Immunodeficiency Virus Infection
    (Wiley Periodicals, Inc., 2020) Ezeamama, Amara .; Zalwango, Sarah .; Tuke, Robert; Lauren, Ricki.; Boivin, Michael .; Musoke, Philippa .; Giordani, Bruno; Sikorskii, Alla
    Caregiver’s and child’s self-reported quality of life (QOL) was defined using standardized questionnaires in a sample (N = 277) of 6–10 years old HIV-infected, HIV-exposed uninfected, and HIV-unexposed uninfected children from Uganda. Psychosocial stress (acute stress and cumulative lifetime adversity) and physiologic stress (dysregulations across 13 biomarkers), perinatal HIV status, and their interaction were related to child QOL via general linear models. Lower child- and caregiver-reported psychosocial stress were dose-dependently associated with higher QOL (acute stress: mean difference coefficient b = 8.1–14.8, effect size [ES] = 0.46–0.83). Lower allostasis was dose-dependently associated with higher QOL (b = 6.1–9.7, ES = 0.34–0.54). Given low caregiver acute stress, QOL for HIV-infected was similar to HIV-uninfected children; however, given high caregiver acute stress, a QOL disadvantage (b = −7.8, 95% CI: −12.8, −2.8; ES = −0.73) was evident for HIV-infected versus uninfected children.Testing of caregiver stress reduction interventions is warranted to increase wellbeing in dependent children.