Improving Assessment for Neurocognitive Impairment among Perinatally HIV Infected Youth

改善围产期艾滋病毒感染青少年神经认知障碍的评估

• 批准号: 9900844
• 负责人: Reuben N Robbins
• 金额: $ 58.95万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9900844
• 关键词: 17 year old; 19 year old; Address; Adherence; Adolescent; Adult; Affect; Age; Anti-Retroviral Agents; Area; Assessment tool; Attention; Behavioral; Brain; Brain imaging; Caring; Child; Chronic; Clinic; Clinical; Clinical Research; Cohort Studies; Data; Decision Making; Detection; Development; Devices; Diagnosis; Disease; Doctor of Philosophy; Education; Employment; Ensure; Europe; Face; Funding; Goals; Gold; Grant; HIV; HIV-infected adolescents; Health; Health Personnel; Health behavior; Healthcare Systems; Hour; Human Resources; Impairment; Individual; Inflammation; Infrastructure; Language; Life; Low Literacy Population; Measures; Medical; Memory; Mental Health; Methods; Monitor; Motor; National Institute of Child Health and Human Development; Neuraxis; Neurocognition; Neurocognitive; Neurocognitive Deficit; Neuropsychological Tests; Outcome; Patients; Performance; Perinatal; Pharmaceutical Preparations; Physicians; Population; Poverty; Preventive Intervention; Principal Investigator; Provider; Psychologist; Psychosocial Factor; Public Health; Research; Research Personnel; Resources; Risk; Risk Behaviors; Sampling; Schools; Screening procedure; Sensitivity and Specificity; Short-Term Memory; Software Engineering; South Africa; Specificity; Speed; Standardization; Structural defect; Tablet Computer; Tablets; Technology; Testing; Time; Training; United States National Institutes of Health; Unsafe Sex; Validation; Virus Diseases; Vulnerable Populations; Youth; base; cognitive function; cohort; computerized; design; executive function; imaging study; improved; innovation; mHealth; meetings; minimally invasive; mobile computing; multidisciplinary; neurocognitive test; neurodevelopment; neuropsychiatry; novel; peer; perinatal HIV; portability; processing speed; psychosocial; recruit; response; screening; sex; smartphone Application; sociodemographic factors; sociodemographics; tool; touchscreen; transmission process

South Africa (SA), a resource limited setting with the world’s largest population of people living with HIV, has hundreds of thousands of perinatally HIV-infected (PHIV+) youth who are rapidly becoming adolescents. PHIV+ adolescents 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+ adolescents 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). PHIV+ youth in SA are also at risk for NCI due to numerous psychosocial problems that are very common in resource limited settings, such as poverty and poor education. The first step in addressing NCI in PHIV+ adolescents is detecting and diagnosing it, but doing so in South Africa is seriously hampered. Few neurocognitive tests and screening tests exist for the hundreds of thousands of PHIV+ youth in SA. The tests that do exist for PHIV+ youth in SA require highly trained personnel to administer and score, take several hours to administer, lack ecological validity to predict real-world outcomes, and many suffer from cultural biases because they were developed for and normed on youth in the US or Europe. Given how overburdened the SA healthcare system is and its reliance on task-shifting various components of care to lay health workers (LHWs), without accurate, clinically useful, and relatively brief NC tests that can detect NCI and meet the demands of task-shifting in RLSs, PHIV+ adolescents in SA will not be assessed, missing opportunities to detect NCI and intervene. NeuroScreen is a brief, easy-to- use app for Android devices to assess and screen for NCI that is designed to be administered by a wide range of non- expert healthcare personnel in clinical settings. The app contains nine 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 validate NeuroScreen for use with PHIV+ adolescents in SA by (1) evaluating its internal validity, (2) sensitivity and specificity to detect NCI compared to a gold standard neuropsychological test battery, and (3) characterize PHIV+ youth performance on it in the context of medical and psychosocial factors. The study will also generate preliminary normative performance data among 13-17 year adolescents in SA. A neurocognitive assessment tool like NeuroScreen could be easily modified for use in other disease populations and regions of the world that rely on task-shifting.

南非（SA）是一个资源有限的环境，拥有世界上最多的艾滋病毒感染者， 成千上万的围产期感染艾滋病毒（PHIV+）的青年正在迅速成为青少年。PHIV+ 青少年必须与终身病毒感染和慢性炎症的负面影响作斗争， 神经发育，医疗状况，心理健康，以及对许多人来说，终身坚持ART的需求- 使他们面临无法实现这些重要里程碑的风险。神经认知障碍（NCI）是其中的主要 这些负面影响。PHIV+青少年的NCI最常影响工作的神经认知领域 内存、执行功能和处理速度。NCI会影响青少年的表现和完成能力 学校，成功地与同龄人和成年人互动，找到工作，建立和保持长期的关系， 并独立运作。NCI也会干扰对药物的依从性，这对HIV至关重要， 增加不良决策和更大的艾滋病毒传播风险行为（例如，无保护的性行为）。PHIV+青少年 在资源有限的南非，由于许多社会心理问题， 例如贫困和教育水平低下。解决PHIV+青少年NCI的第一步是检测 并进行诊断，但在南非这样做受到严重阻碍。很少进行神经认知测试和筛查 在南非，有成千上万的艾滋病毒阳性青年接受检测。在南非确实存在的针对PHIV+青年的测试 需要训练有素的人员进行管理和评分，需要几个小时进行管理，缺乏生态有效性 预测现实世界的结果，许多人遭受文化偏见，因为他们是为 在美国或欧洲的年轻人身上。鉴于SA医疗保健系统负担过重， 将护理的各种组成部分转移给非专业卫生工作者（LHWs），没有准确的，临床有用的， 相对简单的NC测试，可以检测NCI，并满足RLS，PHIV+青少年的任务转移要求 在SA中，将不会被评估，错过了发现NCI和干预的机会。NeuroScreen是一个简单，易于- 使用Android设备的应用程序来评估和筛选NCI，该NCI旨在由广泛的 在临床环境中的非专家医疗保健人员的范围。该应用程序包含九项神经认知测试 评估处理速度、执行功能、工作记忆、文字记忆和运动速度。是 标准化和高度自动化，需要最少的培训来管理，不需要记录- 保持或得分。拟议的研究将通过以下方式验证NeuroScreen用于SA中的PHIV阳性青少年： (1)评价其内部有效性，（2）与金标准相比，检测NCI的灵敏度和特异性 神经心理学测试电池，（3）在医学背景下表征PHIV+青年的表现 和心理社会因素。该研究还将产生13-17岁儿童的初步规范性表现数据。 青春期少年在SA像NeuroScreen这样的神经认知评估工具可以很容易地修改使用 在其他疾病人群和世界上依赖于任务转移的地区。