Hearing and Linked Language Outcomes in children and adolescents affected by HIV and recurrent otitis media - HeLLO - ABSTRACT There are over 100 million children and adolescents globally with hearing loss, including up to 15% of school- age children in the United States. Hearing loss has a profound impact on learning, communication, academic achievement, and future economic and social prospects. In Sub-Saharan Africa, multiple preventable etiologies contribute to high rates of hearing loss, including common infections such as HIV and others causing otitis media with effusions. However, there is little research on the magnitude of hearing loss or its impact on later language and education attainment in children and adolescents living with HIV. Among children exposed to HIV, now estimated to be over 16 million, deficits in language have been observed, but pathways remain largely unclear. Chronic otitis media in early life is a potential mechanism for both hearing and language deficits and presents a modifiable target for intervention. Our team has a unique track record for recruiting, building, and sustaining long-term maternal-child/adolescent cohorts and conducting hearing and extensive neurodevelopmental assessments in children and adolescents living with and exposed to HIV. We propose to leverage existing cohorts and enroll a new cohort of children and adolescents affected by HIV to estimate the magnitude and risk factors for hearing and language impairment and to prospectively ascertain the impact of recurrent otitis media on hearing and language. In aim 1, we will enroll children and adolescents aged 5-19 years living with, and unexposed to HIV to compare differences in prevalence and identify cofactors for otitis media, hearing, language, and literacy. In aim 2, we will enroll 800 infants exposed and unexposed to HIV and follow them with serial middle and inner ear assessments for 30 months to determine the association between incident otitis media and hearing. In aim 3, we will determine the association between incident otitis media and expressive and receptive language outcomes in children enrolled in aim 2. This proposal leverages extensive team experience working with mother-child and adolescent cohorts and hearing and neurodevelopmental assessments to comprehensively understand burden, mechanisms, and hearing and language outcomes from infancy through early adulthood. Our work is supported by a strong national commitment to improve hearing outcomes for children and adolescents in Kenya and established linkages with the Kenya Ear and Hearing Care technical working group. We will work with local, national, and global stakeholders in child health and hearing to discuss study findings, implications, and potential next steps towards ensuring optimal hearing, language development, and educational success for children affected by HIV.
