152 Child development in HIV Exposed, Uninfected Children: Challenges with Accessing Services

HIV exposed, uninfected (HEU) children have higher incidences of neurodevelopmental delay and diagnoses, largely attributed to social determinants that impact their families. In Canada, the majority of mothers living with HIV have experienced significant trauma, and are more likely than the general population to be new to Canada, Indigenous, have a history of IV drug use or incarceration. In a provincial women-and-family-centered HIV clinic, after noticing that many HEUs did not attend recommended early interventions or developmental services despite regular pediatric care and social work support, the following strategies were initiated in 2014: developmental screening every 3–6 months until school age, early referral to interventions, and documentation of referral progress. This quality assurance review aims to characterize the effects of strategies implemented in 2014, and the current developmental needs of HEUs in terms of access to interventions. A retrospective chart review was performed for 169 HEUs, born 2008–2016, with ≥1 clinic visit. Developmental screens, referrals, demographics, and social factors were collected. The adverse childhood experiences (ACE) score was used to measure childhood trauma. HEUs were divided into older/younger cohorts depending on whether they were 18 months of age before/after 2014. All 169 HEUs were screened for developmental delay at nearly every visit, with 45.6% and 42.9% of the younger and older cohort screening positive at some point before the age of 5. A higher proportion of delayed children successfully connected with an early intervention service after 2014 (88.5% vs 63.3%). Of those 5 or older at the time of the study with continued follow-up (50.8%), 33.3% have a developmental diagnosis requiring support at school. The majority had ACEs: 70.4% had ≥1, 9.5% had ≥4. Child protective services (CPS) were involved in 37.3%, 37.8% had financial instability, and 17.1% had housing instability. Developmental concerns were documented in the majority of socially vulnerable HEUs, including those who had CPS involvement (71.4%), ACE ≥4 (78.6%), financial instability (61.3%), and housing instability (71.4%). Smaller proportions of HEUs without these social vulnerabilities had developmental concerns: no CPS involvement (28.3%), ACE <4 (39.9%), no financial (35.3%), and no housing instability (39.7%). HEUs have significant social risk factors that impact their development and access to early interventions. In the setting of subspecialty clinics caring for socially marginalised families, having explicit mechanisms in place to recognize challenges and support development can significantly improve access to early intervention.

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