ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Children and Health
This article is part of the Research TopicViral Infections in Children: Challenges and AdvancesView all articles
Caregiver Assessment of Executive Function Deficits among HIV-Infected and Exposed-Uninfected Preschool children in Kenya
Provisionally accepted
Antipa Sigilai1,2*
Moses K Nyongesa1Amin S Hassan1,2Janet T Thoya2
Rachel Odhiambo1K Katana2Beatrice Kabunda2Grace Bomu2Charles Newton2,3,4
Amina Abubakar1,2,3- 1Aga Khan University (Kenya), Nairobi, Kenya
- 2KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya, Kilifi, Kenya
- 3Department of Psychiatry, University of Oxford, Oxford, UK, Oxford, United Kingdom
- 4University of Queensland,, Sydney, Australia
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Background: This study examined caregiver assessment of executive functioning (EF) in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected (PHEU) Kenyan children and the extent to which various biopsychosocial factors influence EF outcomes. Methods: Children aged 3-5 years that were PHIV (n=43), PHEU (n=52), and HIV-unexposed uninfected (HUU, n=58) and their caregivers were enrolled. EF was measured using the Childhood Executive Functioning Inventory. Shona Symptoms Questionnaire (SSQ) and parenting behaviour scale were used to evaluate caregivers' common mental disorders (CMDs) and parenting behaviour respectively. We used analyses of variance to assess groups' differences in EF scores, and a hierarchal linear regression model to explore covariates associated with EF outcomes. Results: Overall, we observed significant negative effects of HIV exposure on EF scores F (2, 149) =8.591, p<0.001. Compared to HUU children, PHIV children had poor performance in working memory (mean difference (MD), 2.89 [95%CI: 0.65-5.14] p=0.008), inhibitory control (MD, 2.47 [95%CI: 0.55-4.40], p=0.008), and composite EF (MD, 5.37 [95%CI: 1.97-8.76], p=0.001) while PHEU children had poor performance on working memory (MD, 3.24 [95%CI: 1.11-5.37], p=0.001) and composite EF scores (MD, 4.97 [95%CI: 1.75-8.19], p=0.001). The observed EF impairment was strongly associated with caregivers' CMDs and advanced HIV disease in children. Conclusion: Our study suggests that caregivers can observe overt executive dysfunction in children who are perinatally exposed to HIV. These findings underscore the importance of ART adherence in PHIV group and psychosocial support to caregivers of HIV-exposed children to help improve EF outcome.
Keywords: Caregivers, Common mental disorders, Executive Function, HIV-exposed children, Inhibitory Control, working memory
Received: 27 Aug 2025; Accepted: 19 Jan 2026.
Copyright: © 2026 Sigilai, Nyongesa, Hassan, Thoya, Odhiambo, Katana, Kabunda, Bomu, Newton and Abubakar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Antipa Sigilai
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