Modelling the impact of maternal HIV on uninfected children: correcting current estimates

ABSTRACT

A mathematical model, populated primarily with data from South Africa, was developed to model the numbers of children affected by maternal HIV, and the number who will experience long-term negative developmental consequences. A micro-simulation model generated two scenarios. The first simulated a cohort of women whose HIV status mimicked that of a target population, and mother–child dyads by way of age- and disease-specific fertility rates. Factors defining risk were used to characterize the simulated environment. The second scenario simulated mother-child dyads without maternal HIV. In the first scenario an estimated 26% of children are orphaned, compared to 10% in the absence of HIV. And a further 19% of children whose mother is alive when they turn 18 are affected by maternal HIV. School drop-out among all children increased by 4 percentage points because of maternal HIV, similarly population level estimates of abuse and negative mental health outcomes are elevated. Relative to HIV unaffected children, HIV affected have elevated risk of poor outcomes, however not all will suffer long-term negative consequences. Interventions to protect children should target the proportion of children at risk, while interventions to mitigate harm should target the smaller proportion of children who experience long-term negative outcomes..

KEYWORDS:

• Children affected by HIV
• orphans
• micro-simulation
• modelling

Acknowledgments

CD contributed to the design and analysis of the model and drafted the paper. PL programmed the model and commented on drafts, LC analysed data for the model calibration and reviewed and contributed to drafts, MT assisted with model designed and reviewed and contributed to drafts, LR assisted with the analysis of results and reviewed and contributed to drafts XH and MM contributed to literature reviews and contributed to drafting and AW oversaw the model design and programming, and reviewed and commented on drafts. The contents in this article are the sole responsibility of the authors, and do not necessarily reflect the views of USAID, PEPFAR or the United States Government. The contents in this article are those of the authors and do not necessarily reflect the view of the U.S. President's Emergency Plan for AIDS Relief, the U.S. Agency for International Development or the U.S. Government. We thank our fieldwork teams and all participants and their families. USAID/PEPFAR through the Leadership, Management and Governance Project managed by Management Sciences for Health.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

This application was made possible by the support of the American people through the United States Agency for International Development (USAID) under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). MT is supported by the National Research Foundation. The National Research Foundation supports the work of SACEMA. LC would like to acknowledge the funders of the Young Carers study: the Economic and Social Research Council and South African National Research Foundation (RES-062-23-2068), HEARD at the University of KwaZulu-Natal, the South African National Department of Social Development, the Claude Leon Foundation, the John Fell Fund, and the Nuffield Foundation (CPF/41513). Support was provided to LC by European Research Council (ERC) under the European Union's Seventh Framework Programme (FP7/2007-2013)/ ERC grant agreement n°313421 and the Philip Leverhulme Trust (PLP-2014-095).