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

项目摘要 艾滋病毒感染母亲所生的儿童比艾滋病毒感染母亲所生的儿童更有可能出现神经发育迟缓（ND）。 未暴露的儿童。早期识别和转诊到干预服务对改善老年人的生活至关重要。 ND延迟的儿童，但在艾滋病毒流行地区，如撒哈拉以南非洲， 非洲对于每年由感染艾滋病毒的母亲所生的100多万名儿童来说，这是一个重要的错失机会。 将可持续的ND评估计划与筛查、评估和干预服务相结合， 在护理感染艾滋病毒的母亲所生子女的临床系统中，这是迫切需要的。长期 目标是实施有效的ND筛查和干预计划，以防止儿童ND延迟 艾滋病毒感染母亲在资源有限的环境中所生的婴儿。本申请的总体目标是：（1） 确定适当的ND工具用于艾滋病毒暴露的肯尼亚儿童和（2）试点综合 在现有的护理系统内进行ND筛查计划。核心假设是， 使用适当工具的ND评估程序在识别HIV暴露者方面是可行和有效的 肯尼亚的ND延迟儿童。这些目标将通过以下具体努力实现： 目的：1）确定和比较ND筛查工具和评估的信度和效度，以供使用 在肯尼亚18-36个月的儿童中，以及2）评估在现有的 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筛查工具和两种评估的心理测量学特性将在240名 肯尼亚儿童。这将确定一个最佳的筛选工具和评估的设置。下 第二个目标是利用社区参与原则制定一项执行计划， 研究和实施科学。然后将在肯尼亚的一家诊所试行ND筛查计划。 在这一试点范围内，将衡量以下执行成果：可接受性、可行性、忠实性， 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，因为它有可能可持续地改善 HIV暴露儿童的神经发育：1）识别ND延迟的HIV暴露儿童， 2）创建一个研究平台，以支持创新的评估， 干预和跟踪纵向结果。这项研究是创新的，因为它是一个可持续的 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 初步数据，用于对更大规模的执行工作进行成本效益分析。一个综合的， 可持续ND筛查计划将识别和治疗ND延迟的儿童， 评估未来ND延迟干预的平台。

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.