Preparing for Use of a Computerized Battery to Identify Neurocognitive Impairments among HIV-affected Youth in Botswana

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Project Summary Botswana has the third highest prevalence rate of Human Immunodeficiency Virus (HIV) in the world. Due to the high rate of HIV among pregnant women, in utero HIV exposures are common. With the availability of free antiretroviral therapy for children in Botswana since 2003, a large number of perinatally HIV-infected children have aged into adolescence. Children and adolescents (“children”) living with HIV (HIV+) and HIV-exposed- uninfected (HEU) children experience greater neurocognitive deficits than their HIV unexposed (HU) peers. However, tools for assessing neurocognitive functioning in settings such as Botswana are limited. The Penn Computerized Neurocognitive Battery (CNB) is a tool for comprehensive neurocognitive assessment. In an ongoing NIH R01-funded study, the applicant’s primary sponsor and her team are validating a culturally-adapted version of the CNB for use in Botswana. Participants include school-aged children stratified by HIV+/HEU/HU status. The proposed work in this F31 training award builds on the ongoing validation study with unique aims that will serve as the applicant’s dissertation work. The research will lay the foundation for implementing the CNB in Botswana. The proposed research aims to: 1) evaluate the ability of the CNB to distinguish between HIV+ children with and without functionally-significant neurocognitive impairments in Botswana, 2) assess the acceptability of the CNB among youth in Botswana, and 3) identify essential elements for effective use of the CNB in clinical settings in Botswana. The work will provide the applicant with rigorous but well-supported training opportunities while moving her team’s overall research agenda from research tool validation towards application of a practically useful clinical screening tool. Stakeholders’ perspectives’ will inform the development of implementation strategies for use of the CNB in Botswana for the detection of children who are likely to benefit from intervention. It is anticipated that this work will provide robust preliminary data for a post-doctoral fellowship focused on interventions for HIV+ and HEU children with neurodevelopmental impairments. Specifically, this fellowship will enable the applicant to: 1) acquire expertise in leading research in low- and middle-income countries (LMIC), 2) acquire expertise in methodological approaches for comprehensive epidemiologic research, and 3) strengthen research experience within pediatric populations. Through a comprehensive plan including didactic and experiential learning, the applicant will develop skills to prepare for a career as an independent investigator focused on improving the health of children and other vulnerable populations in LMIC through the application of expertise in infectious diseases, Epidemiology, Implementation Science, and public health. This training will position the applicant to comprehensively and systematically address future questions in global child health.