Improving Assessment for Neurocognitive Impairment among Perinatally HIV Infected Youth

改善围产期艾滋病毒感染青少年神经认知障碍的评估

• 批准号: 10118963
• 负责人: Reuben N Robbins
• 金额: $ 35.29万
• 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: 2018-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10118963
• 关键词: 17 year old; 19 year old; Address; Adherence; Adolescent; Adult; Affect; Age; Anti-Retroviral Agents; Area; Assessment tool; Attention; Behavioral; Brain; Brain imaging; Caring; Child; Chronic; Clinic; Clinical; Clinical Research; Cohort Studies; Data; Decision Making; Detection; Development; Devices; Diagnosis; Disease; Doctor of Philosophy; Education; Employment; Ensure; Europe; Face; Funding; Goals; Gold; Grant; HIV; HIV-infected adolescents; Health; Health Personnel; Health behavior; Healthcare Systems; Hour; Human Resources; Impairment; Individual; Inflammation; Infrastructure; Language; Life; Low Literacy Population; Measures; Medical; Memory; Mental Health; Methods; Monitor; Motor; National Institute of Child Health and Human Development; Neuraxis; Neurocognition; Neurocognitive; Neurocognitive Deficit; Neuropsychological Tests; Outcome; Patients; Performance; Perinatal; Pharmaceutical Preparations; Physicians; Population; Poverty; Preventive Intervention; Principal Investigator; Provider; Psychologist; Psychosocial Factor; Public Health; Research; Research Personnel; Resources; Risk; Risk Behaviors; Sampling; Schools; Screening procedure; Sensitivity and Specificity; Short-Term Memory; Software Engineering; South Africa; Specificity; Speed; Standardization; Structural defect; Tablet Computer; Tablets; Technology; Testing; Time; Training; United States National Institutes of Health; Unsafe Sex; Validation; Virus Diseases; Vulnerable Populations; Youth; base; cognitive function; cohort; computerized; design; executive function; imaging study; improved; innovation; mHealth; meetings; minimally invasive; mobile computing; multidisciplinary; neurocognitive test; neurodevelopment; neuropsychiatry; novel; peer; perinatal HIV; portability; processing speed; psychosocial; recruit; response; screening; sex; smartphone Application; sociodemographic factors; sociodemographics; tool; touchscreen; transmission process

South Africa (SA), a resource limited setting with the world’s largest population of people living with HIV, has hundreds of thousands of perinatally HIV-infected (PHIV+) youth who are rapidly becoming adolescents. PHIV+ adolescents 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+ adolescents 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). PHIV+ youth in SA are also at risk for NCI due to numerous psychosocial problems that are very common in resource limited settings, such as poverty and poor education. The first step in addressing NCI in PHIV+ adolescents is detecting and diagnosing it, but doing so in South Africa is seriously hampered. Few neurocognitive tests and screening tests exist for the hundreds of thousands of PHIV+ youth in SA. The tests that do exist for PHIV+ youth in SA require highly trained personnel to administer and score, take several hours to administer, lack ecological validity to predict real-world outcomes, and many suffer from cultural biases because they were developed for and normed on youth in the US or Europe. Given how overburdened the SA healthcare system is and its reliance on task-shifting various components of care to lay health workers (LHWs), without accurate, clinically useful, and relatively brief NC tests that can detect NCI and meet the demands of task-shifting in RLSs, PHIV+ adolescents in SA will not be assessed, missing opportunities to detect NCI and intervene. NeuroScreen is a brief, easy-to- use app for Android devices to assess and screen for NCI that is designed to be administered by a wide range of non- expert healthcare personnel in clinical settings. The app contains nine 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 validate NeuroScreen for use with PHIV+ adolescents in SA by (1) evaluating its internal validity, (2) sensitivity and specificity to detect NCI compared to a gold standard neuropsychological test battery, and (3) characterize PHIV+ youth performance on it in the context of medical and psychosocial factors. The study will also generate preliminary normative performance data among 13-17 year adolescents in SA. A neurocognitive assessment tool like NeuroScreen could be easily modified for use in other disease populations and regions of the world that rely on task-shifting.

南非 (SA) 是一个资源有限、艾滋病毒感染者数量世界上最多的国家， 数十万围产期感染艾滋病毒 (PHIV+) 的青少年正在迅速成长为青少年。艾滋病毒+ 青少年必须应对终生病毒感染和慢性炎症对他们的负面影响 神经发育、医疗状况、心理健康，以及对许多人来说，终生坚持 ART 的要求—— 使他们面临无法实现这些重要里程碑的风险。神经认知障碍（NCI）是其中最主要的 这些负面影响。 PHIV 阳性青少年的 NCI 最常影响工作的神经认知领域 记忆力、执行功能和处理速度。 NCI 可以影响青少年的表现和完成能力 学校，与同龄人和成年人成功互动，找到工作，建立和维持长期关系， 并独立运作。 NCI 还会干扰对药物的依从性，这对于艾滋病毒来说至关重要，并且 增加糟糕的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）。 PHIV+ 青少年 由于在资源有限的地区很常见的许多心理社会问题，南澳州的人也面临 NCI 的风险 环境，例如贫困和教育水平低下。解决 PHIV+ 青少年 NCI 问题的第一步是检测 并对其进行诊断，但在南非这样做受到严重阻碍。很少进行神经认知测试和筛查 南澳有数十万 PHIV+ 青少年接受检测。南澳确实存在针对 PHIV+ 青少年的检测 需要训练有素的人员进行管理和评分，需要几个小时来管理，缺乏生态有效性 来预测现实世界的结果，许多人都遭受文化偏见，因为它们是为和 对美国或欧洲的年轻人进行规范。鉴于南澳医疗保健系统的负担过重及其对 将护理的各个组成部分转移给非专业卫生工作者 (LHW)，但缺乏准确的、临床上有用的和 相对简短的 NC 测试，可以检测 NCI 并满足 RLS、PHIV+ 青少年的任务转移需求 SA 中的患者将不会受到评估，从而错过发现 NCI 和干预的机会。 NeuroScreen 是一个简短、易于使用的 使用适用于 Android 设备的应用程序来评估和筛选旨在由广泛管理的 NCI 临床环境中的一系列非专家医疗保健人员。该应用程序包含九项神经认知测试 评估处理速度、执行功能、工作记忆、言语记忆和运动速度。这是 标准化且高度自动化，需要最少的管理培训，并且不需要记录 保持或得分。拟议的研究将验证 NeuroScreen 在南澳州 PHIV+ 青少年中的应用 (1) 评估其内部有效性，(2) 与金标准相比检测 NCI 的敏感性和特异性 神经心理学测试组，以及 (3) 描述 PHIV+ 青少年在医学背景下的表现 和心理社会因素。该研究还将生成 13-17 岁儿童的初步规范绩效数据 南澳青少年年。像 NeuroScreen 这样的神经认知评估工具可以轻松修改以供使用 在世界上其他依赖任务转移的疾病人群和地区。