Programmatic guidance for interventions to improve early childhood development in high HIV burden countries: a narrative review

Exposure to a multitude of risks, including food insecurity, poverty, and - perhaps most prominently - HIV can be damaging for early childhood survival, healthy growth and development. Yet, guidance regarding the implementation factors that contribute to early child development-focussed programme success is lacking in low- and middle-income countries broadly, and sub-Saharan Africa in particular. Having access to guidelines for practice and implementation could assist in improving the implementation of programmes to improve early childhood development. We conducted a narrative review of the literature with the goal of identifying how implementation features of these early interventions may influence the effectiveness of such work in the complex contexts which characterise this region. Our final review included 197 for final analysis. There were two primary cross-cutting findings. Firstly, the benefit for parents was less clear than they were for children, and secondly, while the benefits for children were clear, those most at risk benefited the most. Home visiting was found to be the predominant service delivery platform, and positive outcomes for children were reported when home visiting programmes were implemented by trained non-professionals, whereas positive parent outcomes were reported more frequently when delivered by professionals. In early childhood care and education programmes, positive outcomes for children and parents were reported when they were implemented by both trained non-professionals and professionals. Trained non-professionals facilitating parent groups produced similar benefits to groups run by professionals. Take-home lessons for successful programmes were that high levels of attendance, regular sessions of at least an hour duration, with the programme continuing for more than 6 months and closer to a year are key for effectiveness.