Using Mobile Technology to Improve Assessment of Neurocognitive Impairment among Perinatally-HIV Infected Youth in Resource Limited Settings

利用移动技术改进资源有限环境下围产期艾滋病毒感染青少年的神经认知障碍评估

• 批准号: 9794131
• 负责人: Reuben N Robbins
• 金额: $ 16.76万
• 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: 2018-09-30 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9794131
• 关键词: 15 year old; Address; Adherence; Adolescence; Adolescent and Young Adult; Adult; Affect; Asians; Behavioral; Brain; Characteristics; Child; Chronic; Clinic; Clinical; Clinical assessments; Country; Cross-Cultural Comparison; Data; Decision Making; Development; Devices; Diagnosis; Disease; Employment; Ensure; Etiology; Europe; Exposure to; Face; Future; Gold; HIV; HIV Infections; HIV-infected adolescents; Health; Healthcare; Hour; Human Resources; Impairment; Individual; Inflammation; Infrastructure; Language; Learning; Life; Linguistics; Measures; Medical; Medical Research; Memory; Mental Health; Microprocessor; Motor; Neurocognitive; Neurocognitive Deficit; Neuropsychological Tests; Nurses; Outcome; Paper; Pathway interactions; Patients; Performance; Pharmaceutical Preparations; Population; Preventive Intervention; Process; Provider; Psychologist; Psychometrics; Public Health; Reaction Time; Research; Research Personnel; Resources; Risk; Risk Behaviors; Schools; Sensitivity and Specificity; Short-Term Memory; Social Workers; South Africa; South African; Speed; Standardization; Structural defect; Tablet Computer; Tablets; Testing; Thailand; Training; Translations; Unsafe Sex; Validation; Viral Load result; Virus Diseases; Work; Youth; base; behavioral health; cohort; computerized; cost; design; executive function; improved; low and middle-income countries; mHealth; medication compliance; mobile computing; neurocognitive test; neurodevelopment; neuroimaging; operation; peer; perinatal HIV; portability; processing speed; psychosocial; resilience; scale up; screening; smartphone Application; tool; touchscreen; transmission process; usability; young adult

There are 2.1 million children 0-15 years of age living with HIV worldwide; the vast majority were perinatally HIV-infected (PHIV), reside in resource limited low-and-middle income countries (LMICs), and are surviving into adolescence and young adulthood. In Thailand, where the proposed study will take place, there are over 14,000 children under 15 living with HIV, and tens of thousands of perinatally HIV-infected (PHIV) adolescents and young adults. PHIV youth 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 youth 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). The first step in addressing NCI in PHIV youth is detecting and diagnosing it, but doing so in Thailand faces numerous challenges. Few neurocognitive screening tests exist for Thai PHIV youth. 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 accurately administered by all levels of clinical staff, PHIV youth in Thailand will not be assessed, missing opportunities to detect NCI and 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 ten 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: (1) adapt NeuroScreen for Thailand and Thai-speaking populations of PHIV youth; (2) generate preliminary estimates of the adapted tests’ validity indicators; (3) examine the adapted NeuroScreen’s usability and acceptability among PHIV Thai youth and clinical staff; and (4) explore associations between NeuroScreen performance and medical (viral load), behavioral health, ART adherence, and neuroimaging outcomes. These data will be the basis for future larger-scale research on validation, implementation and scale-up of this mobile health tool for use in Thailand and other LMICs. NeuroScreen could be easily modified for use in other diseases and LMICs that rely on task-shifting due to limited healthcare resources.

全世界有210万0-15岁的儿童感染艾滋病毒;绝大多数是围产期感染的 艾滋病毒感染者（PHIV），居住在资源有限的低收入和中等收入国家（LMIC）， 进入青春期和青年期。在泰国，拟议的研究将在那里进行， 14，000名15岁以下的艾滋病毒感染儿童和数万名围产期艾滋病毒感染青少年 和年轻人。年轻人必须与终身病毒感染和慢性病毒感染的负面影响作斗争。 炎症对他们的神经发育，医疗状况，心理健康，以及对许多人来说，终身的需求 坚持抗逆转录病毒治疗-使他们处于无法实现这些重要里程碑的风险之中。神经认知障碍 (NCI)是这些负面影响中的主要因素。PHIV青少年的NCI最常影响神经认知功能， 工作记忆、执行功能和处理速度。NCI会影响青少年的表现能力 在校和完成学业，与同龄人和成年人成功互动，找到工作，开始和维持 长期合作，独立运作。NCI也会干扰药物的依从性， 在艾滋病毒中至关重要，并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）。解决PHIV青年NCI的第一步是检测和诊断它，但这样做， 泰国面临许多挑战。很少有神经认知筛查测试存在泰国PHIV青年。测试 需要经过高度训练的人员来管理和评分，需要几个小时来管理， 许多人遭受文化偏见，因为它们是为美国或欧洲的年轻人开发和规范的。 如果没有准确的、临床上有用的、相对简短的NCI评估， 由于各级临床工作人员，泰国的PHIV青少年将不接受评估，错过了发现NCI的机会 进行干预NeuroScreen是一个简短，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。该应用程序包含10项神经认知测试， 处理速度、执行功能、工作记忆、文字记忆和运动速度。它是标准化 和高度自动化，需要最少的培训来管理，并且不需要保存记录或 得分。拟议的研究将：（1）使NeuroScreen适应泰国和讲泰语的PHIV人群 青年;（2）产生适应测试的有效性指标的初步估计;（3）检查适应的 NeuroScreen在泰国PHIV青年和临床工作人员中的可用性和可接受性;以及（4）探索 NeuroScreen表现与医疗（病毒载量）、行为健康、ART之间的关联 依从性和神经影像学结果。这些数据将成为未来更大规模研究的基础 在泰国和其他中低收入国家验证、实施和推广这一移动的保健工具。 NeuroScreen可以很容易地修改用于其他疾病和LMIC，依赖于任务转移， 有限的医疗资源。