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

建立资源来评估低收入和中等收入国家艾滋病毒感染儿童的神经认知受损情况（中低收入国家的 BRAIN Child）

• 批准号: 10311676
• 负责人: Reuben N Robbins
• 金额: $ 25.32万
• 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: 2021
• 资助国家: 美国
• 起止时间: 2021-08-16 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10311676
• 关键词: 12 year old; 13 year old; 15 year old; Address; Adherence; Adolescence; Adolescent; Adult; Affect; Africa; African; Behavioral; Biological; Books; Brain; Child; Childhood; Chronic; Clinic; Clinical; Clinical Research; Community Health Aides; Country; Cross-Cultural Comparison; Data; Decision Making; Detection; Development; Devices; Disease; Early treatment; Environmental Exposure; Equipment; Etiology; Europe; Face; Family; Focus Groups; Future; Gold; HIV; Health; Health Personnel; Healthcare; Hour; Human Resources; Impairment; Individual; Inflammation; Infrastructure; Institution; Joints; Language; Lead; Learning; Life; Link; Longevity; Measures; Medical; Memory; Mental Health; Methods; Motor; Neurocognition; Neurocognitive; Neurocognitive Deficit; Neuropsychological Tests; Nurses; Pathway interactions; Patient-Focused Outcomes; Patients; Performance; Perinatal; Pharmaceutical Preparations; Property; Provider; Psychologist; Psychometrics; Public Health; Rehabilitation therapy; Research; Research Personnel; Research Priority; Resources; Risk; Risk Behaviors; Schools; Services; Short-Term Memory; South Africa; South African; Speed; Standardization; Stimulus; Structural defect; Tablets; Technology; Testing; Thailand; Training; Uganda; United States National Institutes of Health; Universities; Unsafe Sex; Validation; Viral; Virus Diseases; Work; Youth; antiretroviral therapy; base; behavioral health; cognitive interview; cognitive rehabilitation; computerized; design; executive function; improved; low and middle-income countries; mHealth; medication compliance; neurocognitive test; neurodevelopment; pediatric human immunodeficiency virus; peer; performance tests; perinatal HIV; preventive intervention; processing speed; psychosocial; research study; response; scale up; smartphone Application; tool; transmission process; young adult

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.

全世界有210万15岁以下儿童感染艾滋病毒；绝大多数人都有