# Hearing loss in HIV-exposed but uninfected children: Advocating for the role of audiologists in South Africa

## TL;DR

HIV-exposed but uninfected children in South Africa face hearing loss risks, and audiologists are key to early detection and intervention.

## Contribution

The paper advocates for integrating routine audiological assessments into maternal and pediatric HIV healthcare services in South Africa.

## Key findings

- HIV-exposed but uninfected children are at risk of hearing loss due to ototoxic ART, prematurity, and maternal comorbidities.
- Audiologists are underutilized in public healthcare, limiting early detection and intervention for at-risk infants.
- Routine audiological screenings and multidisciplinary EHDI programs can reduce long-term developmental impacts.

## Abstract

Hearing loss in children born to human immunodeficiency virus (HIV)-positive mothers is an emerging public health concern in South Africa. These children, particularly those exposed to antiretroviral therapy (ART) in utero, face heightened risks of auditory impairment predominantly linked to ototoxic ART regimens, prematurity, maternal health comorbidities such as diabetes, and socioeconomic vulnerabilities. While ART has been effective in reducing mother-to-child HIV transmission, evidence suggests that it can also contribute to auditory impairments, impacting early childhood development, language acquisition, and cognitive skills. Audiologists play a crucial role in mitigating these risks through early hearing detection and intervention (EHDI). However, audiologists remain underutilised by both the public and the National Health Department in public healthcare settings with capacity versus demand challenges, and routine audiological screenings for high-risk children, such as HIV-exposed but uninfected infants, are limited.

This article advocates for the integration of routine audiological assessments within maternal and paediatric HIV healthcare services, highlighting the need for structural changes in policy to support preventive audiological care. By establishing comprehensive, multidisciplinary EHDI programmes, South Africa can reduce the long-term developmental and socioeconomic impacts of hearing loss in this vulnerable population, enhancing both individual and public health outcomes.