Preliteracy assessment in children living with HIV in Tanzania: Comparison to results from children living without HIV in Tanzania and the United States

Silvia Bonacina, Christopher Niemczak, Jonathan D. Lichtenstein, Albert Magohe, Abigail Fellows, Trent Nicol, Enica Massawe, Jay C. Buckey, Nina Kraus*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective:Children with HIV (CWH) are at increased risk for cognitive and developmental delays. Whether HIV affects literacy development, however, remains unknown. Rapid automatized naming (RAN) tasks offer the simplest preliteracy assessment a child can perform that predicts future reading skills across languages.Design and Methods:RAN performance was analyzed cross-sectionally on 473 children (249 children without HIV and 217 CWH; ages 3-9) drawn from a longitudinal study in Tanzania. These data were compared to results from 341 normally developing children without HIV (ages 3-8) from the United States. Participants performed two RAN subtests: colors and objects.Results:RAN object completion was greater than for the RAN color in Tanzanian children. CWH were less likely to complete either subtest and performed worse on the object subtest compared to Tanzanian children without HIV. Compared to the US cohort, the Tanzanian cohort was less likely to complete both subtests - in particular the colors subtest - and showed more variability in responses at younger ages. After approximately age 6, however, the trajectory of improvement between the United States and Tanzania was similar.Conclusions:CWH performed worse on this per-literacy test, indicating literacy skill development in CWH needs further study. The differences between US and Tanzanian results likely reflect variability in when children learn to name colors and objects. The trajectory of improvement between countries became more similar as the children aged. This study motivates further longitudinal analyses aimed at assessing the developmental trajectory of the RAN, its predictive ability for reading skills, and its link with other preliteracy and cognitive skills.

Original languageEnglish (US)
Pages (from-to)1077-1083
Number of pages7
Issue number7
StatePublished - Jun 1 2023


  • children with HIV
  • children without HIV
  • developmental trajectory
  • preliteracy
  • rapid automatized naming

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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