Improving Assessment for Neurocognitive Impairment among Perinatally HIV Infected Youth

南非(SA)，一个资源有限的国家，拥有世界上最大的艾滋病毒携带者人口， 数十万围产期感染艾滋病毒(PHIV)的青年正在迅速成为青少年。艾滋病病毒 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，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这些重要里程碑的风险。神经认知障碍(NCI)是 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可能会影响年轻人的表现和完成能力 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， 并独立发挥作用。NCI还会干扰对艾滋病毒至关重要的药物治疗的坚持，以及 增加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)。艾滋病病毒青年 由于许多心理社会问题，在资源有限情况下，SA中的人也面临着NCI的风险 环境，如贫困和教育水平低。解决PHIV青少年NCI的第一步是检测 并对其进行诊断，但在南非这样做严重受阻。很少有神经认知测试和筛查 目前已经对南澳数十万艾滋病病毒感染者进行了检测。在南澳，针对艾滋病病毒年轻人的检测确实存在 需要训练有素的人员来管理和得分，需要几个小时才能管理，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 以美国或欧洲的年轻人为研究对象。鉴于SA医疗系统负担过重及其对 将护理的各个组成部分转移到非专业卫生工作者(LHW)，没有准确的、临床上有用的和 相对简单的NC测验可以检测出NCI并满足RLSS、PHIV青少年的任务转移要求 在SA中将不会被评估，错过了检测NCI和干预的机会。NeuroScreen是一款简短、易于使用的 使用适用于Android设备的应用程序评估和筛选旨在由广泛管理的NCI 临床环境中的非专家医疗保健人员范围。这款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、言语记忆和运动速度。它是 标准化和高度自动化，只需最少的培训即可管理，并且不需要记录- 保持或得分。拟议的研究将通过以下方式验证NeuroScreen用于SA的PHIV青少年 (1)评估其内部效度；(2)与黄金标准相比，检测NCI的敏感性和特异性 神经心理测试组合，以及(3)在医学背景下表征PHIV青年在这方面的表现 以及心理社会因素。这项研究还将在13-17年间产生初步的规范性业绩数据 南卡罗来纳州的青少年。像NeuroScreen这样的神经认知评估工具可以很容易地修改使用 在世界上其他依赖任务转移的疾病人群和地区。

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.