A Computerized Neurocognitive Battery for Use in Youth Affected by HIV in Resource-limited Settings

一种计算机化神经认知电池，用于资源有限环境中受艾滋病毒影响的青少年

• 批准号: 9770640
• 负责人: Elizabeth Dawn Lowenthal
• 金额: $ 38.58万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9770640
• 关键词: 5 year old; Accounting; Adolescent; Adult; Affect; Africa; African; Assessment tool; Attention; Back; Botswana; Caring; Child; Childhood; Clinic; Clinical; Cognition Disorders; Cognitive; Cognitive deficits; Collaborations; Collection; Consumption; Developmental Delay Disorders; Exhibits; Exposure to; Face; Foundations; HIV; HIV Encephalopathy; HIV Infections; HIV therapy; Health Professional; High Prevalence; Hour; Impaired cognition; Incidence; International; Interview; Language; Measures; Neurocognitive; Neurocognitive Deficit; Neurodevelopmental Disorder; Neurodevelopmental Problem; Neuropsychology; Parents; Performance; Perinatal Exposure; Population; Prevalence; Procedures; Psychosocial Assessment and Care; Questionnaires; Reporting; Research; Research Personnel; Resources; School-Age Population; Schools; Screening procedure; Sensitivity and Specificity; Series; Severities; Short-Term Memory; South Africa; Speed; Structure; Symptoms; Testing; Time; Training; Translating; Translations; Validation; Work; Youth; antiretroviral therapy; base; brief screening; caregiver education; child battery; cognitive function; cognitive rehabilitation; cognitive testing; computerized; design; executive function; experience; high risk; implementation science; improved; instrument; member; multidisciplinary; neurobehavioral; neurocognitive disorder; neurocognitive test; neuroimaging; novel; pediatric human immunodeficiency virus; pediatrician; peer; prenatal therapy; processing speed; programs; psychosocial; screening; socioeconomics; teacher; theories; tool

Abstract The introduction of combined antiretroviral therapies has reduced the incidence and severity of HIV-related encephalopathy in youth living with HIV. However, neurodevelopmental delays and cognitive impairment are nonetheless still common in this population. Unfortunately, in resource-limited settings (RLS), where HIV infection impacts millions of children, cognitive and neurodevelopmental disorders commonly go undetected because of a lack of appropriate assessment instruments and local expertise. In this project, we build on the synergistic work of two research groups to: (1) culturally adapt and validate the Penn Computerized Neurocognitive Battery (CNB) and examine its validity for detecting both advanced and subtle neurodevelopmental problems among school-aged HIV-infected and HIV-exposed children in RLS; and (2) simultaneously fine-tune a brief screening instrument (The Pediatric Symptom Checklist, PSC) to prioritize children most likely to benefit from further cognitive assessments. The CNB is a well-validated battery of neurocognitive tests that assesses all major domains of cognitive functioning in adults and children as young as 5 years of age. It has shown sensitivity to mild cognitive deficits, and has been applied in large-scale studies and in multiple cultural contexts. We aim to validate the CNB in youth in Botswana, a RLS with high rates of perinatal exposure to HIV and limited neurocognitive assessment tools and expertise, by culturally adapting and then administering the adapted version of the CNB to 200 HIV-infected, 200 HIV-exposed uninfected, and 240 HIV-unexposed uninfected children. A series of analyses will be conducted to examine the reliability and construct validity of the CNB in these populations. Since a one hour comprehensive cognitive assessment may not be feasible to implement among all children in many busy clinics in resource-limited settings, we will also adapt a rapid psychosocial screening tool, the Pediatric Symptom Checklist to make it suitable for identifying children who are most likely to benefit from further neurocognitive assessment. To accomplish these aims, we have assembled a unique, multi-disciplinary expert team with long-term experience developing and validating novel and highly adaptable neurocognitive assessments, and conducting Africa-based collaborative HIV research. This project will apply procedures for effective translation and cultural adaptation that have been developed through extensive collaborations of our group with international researchers from both Western and non-Western cultures (e.g., in South Africa in an adult Xhosa-speaking population). If successful, the proposed tools would provide practical screening and streamlined, comprehensive assessments that could be widely used in RLS to identify children with cognitive deficits within programs focused on the care and treatment of children living with or affected by HIV. The utility of such assessments could extend well beyond children affected by HIV and increase general access to pediatric cognitive assessments in RLS.

摘要 采用联合抗逆转录病毒疗法减少了艾滋病毒相关疾病的发生率和严重程度， 艾滋病毒感染者的脑病。然而，神经发育迟缓和认知障碍是 但在这个群体中仍然很常见。不幸的是，在资源有限的环境中， 感染影响数百万儿童，认知和神经发育障碍通常未被发现 因为缺乏适当的评估工具和当地专门知识。在这个项目中，我们建立在 两个研究小组的协同工作：（1）文化适应和验证宾夕法尼亚大学计算机化 神经认知成套测验（CNB），并检查其有效性，以检测高级和微妙 RLS中学龄期HIV感染和HIV暴露儿童的神经发育问题;（2） 同时微调一个简短的筛选工具（儿科症状检查表，PSC），以优先考虑 儿童最有可能受益于进一步的认知评估。CNB是一种经过充分验证的电池， 神经认知测试，评估成人和儿童年轻时认知功能的所有主要领域 5岁的时候。它对轻度认知缺陷表现出敏感性，并已应用于大规模研究 在多种文化背景下。我们的目标是在博茨瓦纳的青年中验证CNB，这是一种RLS， 通过文化适应，围产期接触艾滋病毒以及有限的神经认知评估工具和专业知识 然后给200名HIV感染者、200名HIV暴露者和200名未感染者施用适应版本的CNB， 240名未感染艾滋病毒的儿童。将进行一系列分析，以检查可靠性， CNB在这些人群中的结构效度。因为一个小时的全面认知评估可能 在资源有限的情况下，在许多忙碌的诊所的所有儿童中实施是不可行的，我们还将 采用一种快速的社会心理筛查工具，即儿科症状检查表，使其适合于识别 最有可能受益于进一步神经认知评估的儿童。为了实现这些目标，我们 组建了一支独特的多学科专家团队，拥有长期的开发和验证经验 新颖且适应性强的神经认知评估，并开展基于非洲的艾滋病毒合作 research.本项目将采用有效的翻译和文化适应程序， 通过我们小组与来自西方和欧洲的国际研究人员的广泛合作， 非西方文化（例如，在南非的科萨语成年人群中）。如果成功，建议 工具将提供实用的筛选和简化的全面评估， 在RLS中用于识别儿童认知缺陷的计划，重点是护理和治疗 受艾滋病毒感染或影响的儿童。这种评估的效用可以远远超出儿童 受艾滋病毒影响的儿童，并增加RLS中儿科认知评估的普遍可及性。