Principal Investigator - Kathleen Powis, MD, MPH, MBA | Michelle Bulterys PhD

Study Objectives:

Primary Study Specific Aims

Aim 1: Using qualitative methods, characterize patterns of household composition and family dynamics for caregiving, and the role of nurturing care in promoting healthy neurodevelopment among children in Botswana.  Approach: We will conduct semi-structured focus group discussions and in-depth interviews with up to 30 mothers purposively sampled from within the FLOURISH study cohort to capture an array of experiences (e.g., first-time/young mothers, experienced mothers, mothers living with HIV). We will incorporate “vignette narratives” and “participatory visual mapping” to engage group members. Interactive discussions will map out the people involved in child rearing and common challenges in relation to the Nurturing Care Framework domains. Exploratory, inductive thematic analyses will be used to describe common family structures in this cultural context and distill caregiver perspectives on the nurturing care factors that promote healthy child neurodevelopment.

Aim 2: Using mixed methods, assess the associations between child HIV exposure, caregiver relationship factors, and child neurodevelopment. Approach: We will quantify the associations between caregiver relationship factors, child HIV exposure status, and child neurodevelopment using the Caregiver Reported Early Developmental Instruments (CREDI) Long Form administered to caregivers of children six months of age participating in the FLOURISH study. We will fit multivariable linear regression models, testing for effect modification by child HIV exposure status.

Simultaneously, qualitative data will be collected from up to 30 mothers enrolled in the FLOURISH study who will participate in focus group discussions exploring how their relationship satisfaction and other factors may impact their caregiving. We will then use convergent parallel triangulation to jointly interpret quantitative and qualitative research findings. Final concepts will be organized into broad categories, such as factors that contribute to caregiver/partner relationship satisfaction vs. tension, how challenges are overcome, and ways in which their relationships may influence caregiving.

Secondary Study Specific Aims

Aim 3: Evaluate differences in growth by infant HIV exposure status at six-months of life.

Aim 4: Evaluate compliance with Botswana National HIV testing standards for women without HIV who are breastfeeding and for infants with HIV exposure.

Study Design:

Mixed methods, cross-sectional analysis nested within a prospective longitudinal cohort study. The FACET sub-study (Family Dynamics and Child Neurodevelopment in Botswana) will be a nested mixed methods analysis leveraging the birth cohort within the FLOURISH study (R33 HD103099; PIs: Powis, Jao, Makhema), involving women enrolled during pregnancy.

Study population and Size:

The study will co-enrol up to 200 mothers-infant pairs, 100 of whom will be pairs of mothers living with HIV and CHEU, will provide quantitative data. Up to 30 FACET mothers will provide qualitative data gathered in a Focus Group Discussion                                                                                                           

Study duration: 04/01/2023 – 03/31/2024

Study Results: Study is on-going and no results yet.

Sponsor: National Institute of Child Health and Human Development (NICHD)