Grants Enable AMPATH Neurodevelopmental Research to Improve Care
Throughout the world, children and adolescents with developmental delays and other neurological conditions face daily challenges. In resource-limited settings, lack of early diagnosis, community understanding and available interventions compound these challenges.
In Kenya, children with disabilities may be considered cursed and can face additional stigma, isolation or neglect.
With support from a series of new research grants, a dedicated team of AMPATH physicians and researchers aims to improve the future for children and adolescents with autism, developmental delays, and other neurological challenges in Kenya and other resource-limited areas. While each of the grants focuses on a different area of investigation, together they are building an infrastructure to advance neurodevelopmental care through evaluation; identifying risk factors and interventions; and training Kenyan researchers to advance scientific knowledge and skills in brain neurophysiology.
Megan McHenry, MD, MS, an IU School of Medicine pediatrician and researcher focused on child neurodevelopment, received a five-year R01 research grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) entitled “Predicting neurodevelopmental risk in children born to mothers living with HIV in Kenya.” The project, with her Moi University collaborator and co-principal investigator Eren Oyungu, MBChB, MMED, MPH, seeks to identify risk factors associated with poor neurodevelopment in the first two years of life and compares the neurodevelopment of 500 children who were born to mothers living with HIV but who are themselves uninfected to the development of 500 children born to mothers who are HIV uninfected. Ultimately the project strives to develop a risk assessment tool to predict which children are at greatest risk for worse neurodevelopmental outcomes by their second birthday.
Dr. Eren Oyungu examines a patient’s images.
“Preventing the vast majority of transmission of HIV from mothers to their children is one of AMPATH’s many successes,” said Dr. McHenry. “However, many children born to mothers living with HIV are not thriving. Our team will explore the interaction between HIV exposure and child neurodevelopment. The eventual development of a risk assessment tool will enable appropriate interventions to be directed to those most in need as early as possible,” she continued.
“Early intervention will determine the potential of these children to meet their future capabilities,” said Dr. Oyungu.
This project builds upon earlier research by Drs. McHenry and Oyungu to culturally-adapt the Bayley Scales of Infant and Toddler Development, 3rd edition, for use in Kenya. This tool and the Child Behavior Checklist will be utilized to compare the cognition, behavior, and language and motor development between the two groups of children. These children and their mothers will be recruited from a large cohort within the East Africa International epidemiology Databases to Evaluate AIDS (IeDEA) group.
The AMPATH team also received an R21 grant from the National Institute of Mental Health (NIMH) entitled “Advancing the science of neurocognitive physiology in adolescents living with HIV.” As life expectancy increases due to antiretroviral therapy, how HIV affects the developing brain extending into adolescence is not well understood especially in sub-Saharan Africa. This project will focus on identifying changes in neuron function in the brains of adolescents who acquired HIV around the time of birth.
Using electroencephalographic (EEG) recordings made during specific sensory, cognitive or motor tasks, the research team hopes to identify the specific changes in the brain’s electrical responses and compare them to a similar group of adolescents who are HIV uninfected. Both study groups will also complete a tablet-based cognitive assessment, called the NIH Toolbox Fluid Cognition Tests which has also been culturally-adapted by the AMPATH team for use in Kenya.
“This grant is not only an opportunity for us to learn more about the neurophysiology of HIV-infected adolescents, but it will also provide us with the opportunities to build infrastructure to answer a wide range of mental health conditions in Kenya,” said study co-principal investigator David Ayuku, PhD, Moi University School of Medicine. “HIV-infected adolescents are faced with many challenges that may impact their neurocognitive states, but little is known about the neurophysiological impacts of HIV and antiretroviral treatment,” he continued. The participants for this study will be recruited from an existing long-term research cohort which will also enable this research to examine other potential factors impacting neurodevelopment such as HIV-related medical history, adverse life events and childhood malnutrition.
The project will also provide the foundation for building interdisciplinary neurophysiological research at Moi University in Kenya. A new master’s degree program in Medical Psychology at the university has enhanced the research and mentorship infrastructure to support research on brain and nervous system diseases. As part of this AMPATH R21 research project, a series of training workshops, monthly virtual seminars and on-site supervision will support the faculty and students within the program in performing neuropsychological work for both clinical and research purposes.
In addition to Drs. Ayuku and McHenry, the R21 award includes co-investigator Dr. Oyungu, Winstone Nyandiko, MBChB, MMED, MPH, Moi University School of Medicine and Rachel Vreeman, MD, MS, Icahn School of Medicine at Mount Sinai.
Capacity building is also the focus of a reciprocal innovation planning grant awarded to the AMPATH partnership entitled “Community-based Caregiver Training Intervention for Children with Autism,” funded by the Indiana Clinical and Translational Sciences Institute (CTSI) in cooperation with the Indiana University Center for Global Health. This planning grant will foster a new collaboration aimed at improving autism care for children and their families living in low-resourced settings including rural Indiana and western Kenya. An international visit will foster communication surrounding innovations and lessons learned about implementation of evidence-based autism care in communities within each context. Reciprocal innovation is the concept of taking health innovations developed to address a challenge in one setting and adapting them to meet similar challenges in other settings.
In March 2022, four Kenyan faculty members including pediatricians Dr. Oyungu and Dr. Barnabas Kigen, psychiatrist Dr. Asha Mwangi, and Mr. Naphtali Yego, head of department of occupational therapy at Moi Teaching and Referral Hospital in Kenya will visit colleagues at Indiana University including Dr. McHenry and clinical psychologist Dr. Rebecca McNally Keehn. During the visit, the team will tour and observe innovations in care in Indiana, such as various autism interventions and Early Autism Evaluation Hubs. The Kenyan professionals will guide a discussion focused on forming a community health worker model widely used in Kenya and adapting it to the current system in Indiana. The exchange is expected to lead to an application for further funding a reciprocal innovation for a caregiver-focused intervention for autism.
Reflecting on the impact of AMPATH’s combined research, training and care efforts, Dr. Oyungu concluded, “I see a future where we may be able to improve the potential of children with both mental and neurological disabilities. I see a future where this program may be able to increase the number of children with disabilities who improve their potential to play, develop, learn and participate in the general growth of this country.”