Neurodevelopmental screening in children born to HIV-infected mothers in Kenya

项目概要 感染艾滋病毒的母亲所生的孩子比感染艾滋病毒的母亲所生的孩子更有可能出现神经发育迟缓（ND）。 未接触过的儿童。早期识别和转介干预服务对于改善患者的生活至关重要 ND 延迟的儿童，但在艾滋病毒流行地区（例如撒哈拉以南地区）并不常规进行 非洲。对于每年超过 100 万感染艾滋病毒的母亲所生的孩子来说，这是一个严重的错失机会。 将可持续的 ND 评估计划与筛查、评估和干预服务相结合是 在照顾感染艾滋病毒的母亲所生的孩子的临床系统中迫切需要。长期来看 目标是实施有效的 ND 筛查和干预计划，以解决儿童 ND 延误问题 感染艾滋病毒的母亲在资源有限的环境中所生的孩子。该应用程序的总体目标是：（1） 确定适用于感染艾滋病毒的肯尼亚儿童的 ND 工具，以及 (2) 试点综合性的 现有护理系统内的 ND 筛查计划。中心假设是整合 使用适当工具的 ND 评估计划在识别 HIV 暴露方面将是可行且有效的 肯尼亚患有 ND 延迟的儿童。这些目标将通过追求以下具体目标来实现 目标：1) 确定并比较 ND 筛查工具和使用评估的可靠性和有效性 在肯尼亚 18-36 个月的儿童中进行，2) 评估现有国家 ND 筛查的实施情况 肯尼亚的医疗保健系统。在第一个目标下，将进行严格的跨文化适应， 两种 ND 筛查工具和两项评估的心理测量特性将在 240 名受试者中进行评估 肯尼亚儿童。这将为该环​​境确定最佳的筛选工具和评估。下 第二个目标，将利用基于社区的参与原则制定实施计划 研究和实施科学。随后，一项 ND 筛查计划将在肯尼亚的一家诊所进行试点。 在该试点中，将衡量以下实施结果：可接受性、可行性、保真度、 实施成本和可持续性。 ND 筛查在识别 ND 延迟方面的诊断准确性 也将被确定。这项研究意义重大，因为它有可能持续改善 通过以下方式检测 HIV 暴露儿童的神经发育： 1) 识别 ND 延迟的 HIV 暴露儿童 向他们推荐治疗，2) 创建一个研究平台来支持创新的评估 干预措施并跟踪纵向结果。拟议的研究具有创新性，因为可持续 ND 筛查计划将被创建并整合到当前的护理模式中。这将提供 用于对更大规模实施进行成本效益分析的初步数据。一个集成的、 可持续的 ND 筛查计划将识别和治疗患有 ND 延迟的儿童，并开展一项研究 评估未来 ND 延迟干预措施的平台。

PROJECT SUMMARY Children born to HIV-infected mothers are more likely to have neurodevelopmental (ND) delays than HIV- unexposed children. Early identification and referral to intervention services is critical to improve the lives of children with ND delays, but it is not routinely performed in HIV-prevalent areas, such as sub-Saharan Africa. This is a critical missed opportunity for the >1 million children born to HIV-infected mothers annually. Integrating sustainable ND evaluation programs, with screening, assessment, and intervention services, is critically needed within clinical systems caring for children born to HIV-infected mothers. The long-term goal is to implement an effective ND screening and intervention program to combat ND delays in children born to HIV-infected mothers in resource-limited settings. The overall objectives of this application are: (1) to identify appropriate ND instruments for use in HIV-exposed Kenyan children and (2) to pilot an integrated ND screening program within the existing care system. The central hypothesis is that the integration of a ND evaluation program using appropriate tools will be feasible and effective at identifying HIV-exposed children with ND delays in Kenya. These objectives will be achieved by pursuing the following specific aims: 1) Determine and compare the reliability and validity of ND screening tools and assessments for use among children aged 18-36 months in Kenya and 2) Evaluate ND screening implementation in an existing health care system in Kenya. Under the first aim, a rigorous cross-cultural adaptation will be performed, and psychometric properties of two ND screening tools and two assessments will be evaluated among 240 Kenyan children. This will identify an optimal screening tool and assessment for the setting. Under the second aim, an implementation plan will be developed using principles of community-based participatory research and implementation science. An ND screening program will then be piloted at one clinic in Kenya. Within this pilot, the following implementation outcomes will be measured: acceptability, feasibility, fidelity, implementation cost, and sustainability. The diagnostic accuracy of ND screening at identifying ND delays will also be determined. This study is significant because of its potential to sustainably improve the neurodevelopment of HIV-exposed children by: 1) identifying HIV-exposed children with ND delays and referring them to therapy and 2) creating a research platform to support the evaluation of innovative interventions and track longitudinal outcomes. The proposed research is innovative because a sustainable ND screening program will be created and integrated within the current model of care. This will provide preliminary data for a cost-effectiveness analysis of a larger scale-up of implementation. An integrated, sustainable ND screening program will identify and treat children with ND delays and create a research platform to evaluate future interventions for ND delays.