New Instrument for Adverse Childhood Experiences in HIV-Positive Zambian Children

Abstract

Purpose

Adverse childhood experiences (ACE) drive a variety of poor health outcomes, including anxiety, depression, and cognitive impairment. Little is known about the impact of ACE in HIV-positive children in Sub-Saharan Africa. We sought to develop and validate a culturally-sensitive instrument to evaluate ACE in HIV-positive Zambian children.

Methods

This was a prospective mixed-methods study within HIV-Associated Neurocognitive Disorders in Zambia (HANDZ), a longitudinal cohort study of children with HIV in Zambia, Africa. Qualitative interviews with families and community experts were conducted to generate a battery of questions for Adverse Life Experiences in Zambia (ALEZ) in three domains: violence exposure, serious illness, and family stressors. Standardized NIH Toolbox neuropsychological batteries of sadness, fearfulness, depression and anxiety were administered annually. The World Health Organization Adverse Childhood Experiences International Questionnaire (ACEIQ) was administered for comparison. Face, convergent and content validity were assessed using multivariate linear regression analyses.

Results

The baseline sample consisted of 331 HIV-positive, 208 HIV-exposed uninfected (HEU) and 75 HIV-unexposed uninfected (HUU) children. Interviews and linear regression analyses between ALEZ and ACE-IQ established face, content, and criterion validity. HIV-positive children experienced increased average NIH-Toolbox sadness and fearful emotion, but there were no significant differences in prevalence of depression and anxiety among all groups. ALEZ z-scores were more positively-correlated to sadness and fearful emotion than ACE-IQ z-scores.

Conclusion

ALEZ was the first instrument designed to measure ACE in Sub-Saharan Africa with appropriate face, content, and construct validity. Further studies are needed to establish ALEZ reliability predictive validity.