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

全世界有210万名0-15岁的儿童携带艾滋病毒；其中绝大多数是围产期的。 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，正在生存 进入青春期和青春期。在泰国，拟议的研究将在那里进行，有超过 14,000名15岁以下儿童感染艾滋病毒，以及数万名围产期感染艾滋病毒的青少年 和年轻人。艾滋病毒青年必须与终身病毒感染和慢性艾滋病的负面影响作斗争 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，对终身的需求 坚持艺术--让他们面临无法实现这些重要里程碑的风险。神经认知障碍 在这些负面影响中，(NCI)是最主要的。PHIV青年的NCI最常影响神经认知 工作记忆、执行功能和处理速度的领域。NCI可能会影响年轻人的表演能力 在校期间和完成学业，成功地与同龄人和成年人互动，找到工作，启动和维护 长期的关系，并独立运作。NCI还会干扰对药物的坚持，这 对艾滋病毒来说是关键的，并增加了糟糕的决策和更大的艾滋病毒传播风险行为(例如， 无保护措施的性行为)。解决PHIV青年NCI的第一步是检测和诊断它，但在 泰国面临诸多挑战。泰国艾滋病毒青少年的神经认知筛查测试很少。测试 确实存在需要训练有素的人员来管理和评分，需要几个小时的管理，以及 许多人遭受文化偏见，因为他们是为美国或欧洲的年轻人开发的，并以他们为规范。 没有准确的、临床上有用的、相对简短的、可以准确管理的NCI评估 各级临床工作人员不会对泰国PHIV青年进行评估，错失检测NCI的机会 并进行干预。NeuroScreen是一款简短、易于使用的安卓设备应用程序，用于评估NCI 设计供各级临床工作人员使用。这款应用包含十项神经认知测试，评估 处理速度、执行功能、工作记忆、言语记忆和运动速度。它是标准化的 和高度自动化，只需要最低限度的培训即可管理，不需要保存记录或 得分。拟议的研究将：(1)使NeuroScreen适用于泰国和说泰语的PHIV人群 青年；(2)生成适应测验的效度指标的初步估计；(3)检查适应的 NeuroScreen在泰国艾滋病青年和临床工作人员中的可用性和接受性；以及(4)探索 NeuroScreen表现与医疗(病毒载量)、行为健康、ART之间的关系 依从性和神经成像结果。这些数据将成为未来更大规模研究的基础 关于在泰国和其他小岛屿发展中国家使用的这一移动保健工具的验证、实施和扩大。 NeuroScreen可以很容易地进行修改，以用于其他疾病和依赖任务转移的LMIC 有限的医疗资源。

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.