Enhancing Research for Inflammation and Cognitive Health in Perinatally Acquired HIV (ENRICH PHIV)

全世界有210万名0-15岁的儿童携带艾滋病毒；其中绝大多数是围产期感染的 获得性艾滋病毒(PHIV)，居住在资源有限的低收入和中等收入国家，并正在生存 进入青春期和青春期。在乌干达，拟议的研究将在那里进行，有超过 13万名15岁以下儿童感染艾滋病毒，绝大多数感染艾滋病毒，还有数万名儿童 艾滋病毒携带者超过15年。感染艾滋病毒的青年必须与终身病毒感染的负面影响作斗争， 慢性炎症对他们的神经发育、医疗状况、心理健康以及对许多人的需求 终生坚持艺术--让他们面临无法实现这些重要里程碑的风险。神经认知 在这些负面影响中，损害(NCI)是最主要的。感染艾滋病毒的青少年中的NCI最常影响 工作记忆、执行功能和处理速度的神经认知领域。NCI可以影响年轻人的 能够在学校表现良好并完成学业，与同龄人和成年人成功互动，找到工作，启动 并保持长期的关系，并独立运作。NCI还会干扰对 药物治疗，这是艾滋病毒的关键，增加了糟糕的决策和更大的艾滋病毒传播风险 行为(例如，无保护措施的性行为)。在PHIV青年中解决NCI的第一步是检测和诊断它， 但在泰国这样做面临着许多挑战。对乌干达年轻人来说，很少有神经认知测试 艾滋病病毒。现有的考试需要训练有素的人员来管理和评分，需要几个小时才能完成 管理，许多人遭受文化偏见，因为他们是为年轻人开发的，并以 美国或欧洲。如果没有准确的、临床上有用的和相对简短的NCI评估 由各级工作人员、研究人员和临床医生管理，他们评估的能力将受到严重限制 乌干达艾滋病毒携带者青年错过了研究和检测非传染性疾病以及干预的机会。神经屏 是一款用于Android设备的简短、易于使用的应用程序，用于评估NCI，旨在由所有人管理 临床工作人员的级别。这款应用程序包含10个神经认知测试，用于评估处理速度 功能、工作记忆、言语记忆和运动速度。它是标准化和高度自动化的， 管理只需要最低限度的培训，不需要保存记录或评分。建议进行的研究 将：(1)使NeuroScreen适用于乌干达和卢甘达语人群感染艾滋病毒的青年，并评估 调整NeuroScreen在乌干达艾滋病毒携带者青年和临床工作人员中的可用性和可接受性；(2) 生成改编测试的效度指标的初步估计；(3)检查改编的 NeuroScreen在泰国艾滋病青年和临床工作人员中的可用性和接受性；以及(3)探索 神经筛查功能与炎症和免疫激活标志物之间的关系。这些 这些数据将成为未来关于NCI和炎症的更大规模研究的基础，以及验证， 实施和扩大这一移动保健工具，以便在乌干达和其他小岛屿发展中国家使用。

There are 2.1 million children 0-15 years of age living with HIV worldwide; the vast majority have perinatally acquired HIV (PHIV), reside in resource limited low-and-middle income countries (LMICs), and are surviving into adolescence and young adulthood. In Uganda, where the proposed study will take place, there are over 130,000 children under 15 years living with HIV, the vast majority with PHIV, and tens of thousands more living with PHIV over 15 years. Youth with PHIV must contend with the negative effects of life-long viral infection and chronic inflammation on their neurodevelopment, medical status, mental health, and, for many, the demands of lifelong ART adherence – placing them at risk for not achieving these important milestones. Neurocognitive impairment (NCI) is chief among these negative effects. NCI in PHIV youth most commonly affects the neurocognitive domains of working memory, executive function and processing speed. NCI can affect youth’s ability to perform in and complete school, interact successfully with peers and adults, find employment, initiate and maintain long-term relationships, and function independently. NCI can also interfere with adherence to medication, which is critical in HIV, and increase poor decision-making and greater HIV transmission risk behaviors (e.g., unprotected sex). The first step in addressing NCI in PHIV youth is detecting and diagnosing it, but doing so in Thailand faces numerous challenges. Few neurocognitive tests exist for Ugandan youth with PHIV. The tests that do exist require highly trained personnel to administer and score, take several hours to administer, and many suffer from cultural biases because they were developed for and normed on youth in the US or Europe. Without accurate, clinically useful, and relatively brief NCI assessments that can be accurately administered by all levels of staff, researchers and clinicians will be severely limited in their capacity to assess youth with PHIV in Uganda, missing opportunities to study and detect NCI, as well as intervene. NeuroScreen is a brief, easy-to-use app for Android devices to assess for NCI that is designed to be administered by all levels of clinical staff. The app contains ten neurocognitive tests assessing processing speed, executive functions, working memory, verbal memory, and motor speed. It is standardized and highly automated, requires minimal training to administer, and does not require record-keeping or scoring. The proposed study will: (1) adapt NeuroScreen for Uganda and Luganda-speaking populations youth with PHIV and evaluated the adapted NeuroScreen’s usability and acceptability among Ugandan youth with PHIV and clinical staff; (2) generate preliminary estimates of the adapted tests’ validity indicators; (3) examine the adapted NeuroScreen’s usability and acceptability among PHIV Thai youth and clinical staff; and (3) explore associations between NeuroScreen performance and markers of inflammation and immune activation. These data will be the basis for future larger-scale research studies on NCI and inflammation, as well as validation, implementation and scale-up of this mHealth tool for use in Uganda and other LMICs.