Building Resources to Assess Impaired Neurocognition in Children with HIV in Low- and Middle-Income Countries (BRAIN Child in LMICs)

全世界有210万15岁以下的儿童感染艾滋病毒；绝大多数儿童 通过围产期获得的艾滋病毒，居住在资源有限的低收入和中等收入国家， 活到青春期和青春期。在乌干达，拟议的研究将在那里进行， 在15岁以下超过13万CWH。CWH必须与终身病毒感染的负面影响作斗争 以及慢性炎症对他们的神经发育、医疗状况、精神健康以及对许多人来说， 终身坚持艺术的要求--使他们面临无法实现关键发展里程碑的风险。 在这些负面影响中，神经认知障碍(NCI)是最主要的。CWH中的NCI最常见的影响 工作记忆、执行功能和处理速度的神经认知领域。NCI可能会影响 儿童在学校的表现和完成学业的能力，与同龄人和成年人成功互动的能力，启动和 保持长期的关系，培养独立性。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 年龄较大的儿童和青少年的行为(例如，无保护措施的性行为)。在CWH解决NCI问题的第一步 正在检测到它，但在乌干达这样做面临着许多挑战。乌干达人的神经认知测试很少 5-12岁的儿童。确实存在的考试需要训练有素的人员来管理和评分， 需要几个小时的时间来管理，许多人遭受文化偏见，因为他们是为 以美国或欧洲的年轻人为研究对象。没有准确的、临床上有用的和相对简短的NCI评估 所有级别的工作人员、研究人员和临床医生都可以准确地实施，但仍将受到严重限制 在乌干达评估CWH的能力，错失了研究和发现NCI的机会，以及 进行干预。NeuroScreen是一款简短、易于使用的Android设备应用程序，用于评估NCI，旨在 由各级临床工作人员管理。这款应用程序包含12项神经认知测试，评估处理过程 速度、执行功能、工作记忆、言语记忆和运动速度。它是标准化的，高度的 自动化，只需最少的培训即可管理，不需要保存记录或评分。一直以来 成功地用于成人和青少年，但尚未评估用于13岁以下儿童 好几年了。拟议的研究将：(1)确定使NeuroScreen可用所需的必要适应， 13岁以下的CWH和可能管理它的艾滋病毒提供者可以理解和接受；(2) 对CHW和匹配对照5-12之间的适应性测试的效度指标进行初步估计 以及(3)探索NeuroScreen表现和行为健康之间的关系。这些 数据将成为未来关于NCI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在乌干达和其他小岛屿发展中国家的使用。

There are 2.1 million children with HIV (CWH) under 15 years of age worldwide; the vast majority have perinatally-acquired HIV, 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 CWH under 15 years. CWH 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 crucial developmental milestones. Neurocognitive impairment (NCI) is chief among these negative effects. NCI in CWH most commonly affects the neurocognitive domains of working memory, executive functions, and processing speed. NCI can affect children’s ability to perform in and complete school, interact successfully with peers and adults, initiate and maintain long-term relationships, and develop independence. 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) for older children and adolescents. The first step in addressing NCI in CWH is detecting it but doing so in Uganda faces numerous challenges. Few neurocognitive tests exist for Ugandan children 5-12 years of age. 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 administered accurately by all levels of staff, researchers and clinicians will remain severely limited in their capacity to assess CWH 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 twelve 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. It has been used successfully with adults and adolescents but has not been evaluated for use with children under 13 years. The proposed study will: (1) determine the necessary adaptations needed to make NeuroScreen usable, understandable, and acceptable to CWH under 13 years, and for HIV providers likely to administer it; (2) generate preliminary estimates of the adapted tests’ validity indicators among CHW and matched controls 5-12 years of age; and (3) explore associations between NeuroScreen performance and behavioral health. These data will be the basis for future larger-scale research studies on NCI, as well as validation, implementation and scale-up of this mHealth tool for use in Uganda and other LMICs.