Neurodevelopment of the children at 24–28 months was assessed with the Bayley Scales of Infant and Toddler Development, third edition (BSID-III) assessment (Bayley, 2006, Donald et al., 2018). The BSID-III is a well-validated tool that assesses child cognitive, language and motor development from 1 to 42 months and is sensitive to developmental delay (Bayley, 2006). The BSID-III testing was performed by trained assessors that were blinded to maternal HIV status. Training was performed in accordance with the BSID manual by a pediatric neurodevelopmental specialist who periodically monitored the assessors throughout the testing period to validate standardized data collection across sites and ensure agreement between assessors on both administration and scoring. The assessors alternated between the TC Newman and Mbekweni clinics and assessed equal number of children at each site. Assessments were performed with prompts in the child’s preferred language. External scoring quality control checks were also performed centrally before data capture. For the current study standardized composite scores were used. Composite scores were generated for each cognitive, language and motor domain, with a mean of 100 and standard deviation of 15, using normative United States data. The use of these composite scores have been validated in the South African setting (Ballot et al., 2017, Rademeyer and Jacklin, 2013).

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