Building Resources to Assess Impaired Neurocognition in Children with HIV in Low- and Middle-Income Countries (BRAIN Child in LMICs)

建立资源来评估低收入和中等收入国家艾滋病毒感染儿童的神经认知受损情况（中低收入国家的 BRAIN Child）

• 批准号: 10471974
• 负责人: Reuben N Robbins
• 金额: $ 18.22万
• 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: 2021
• 资助国家: 美国
• 起止时间: 2021-08-16 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10471974
• 关键词: 12 year old; 13 year old; 15 year old; Address; Adherence; Adolescence; Adolescent; Adult; Affect; Africa; African; Behavioral; Biological; Books; Brain; Child; Childhood; Chronic; Clinic; Clinical; Clinical Research; Community Health Aides; Country; Cross-Cultural Comparison; Data; Decision Making; Detection; Development; Devices; Disease; Early treatment; Environmental Exposure; Equipment; Etiology; Europe; Face; Family; Focus Groups; Future; Gold; HIV; HIV-infected adolescents; Health; Health Personnel; Healthcare; Hour; Human Resources; Impairment; Individual; Inflammation; Infrastructure; Institution; Joints; Language; Lead; Learning; Life; Link; Longevity; Measures; Medical; Memory; Mental Health; Methods; Motor; Neurocognition; Neurocognitive; Neurocognitive Deficit; Neuropsychological Tests; Nurses; Pathway interactions; Patient-Focused Outcomes; Patients; Performance; Perinatal; Pharmaceutical Preparations; Property; Provider; Psychologist; Psychometrics; Public Health; Rehabilitation therapy; Research; Research Personnel; Research Priority; Resources; Risk; Risk Behaviors; Schools; Services; Short-Term Memory; South Africa; South African; Speed; Standardization; Stimulus; Structural defect; Tablets; Technology; Testing; Thailand; Training; Uganda; United States National Institutes of Health; Universities; Unsafe Sex; Validation; Viral; Virus Diseases; Work; Youth; antiretroviral therapy; base; behavioral health; cognitive interview; cognitive rehabilitation; computerized; design; executive function; improved; low and middle-income countries; mHealth; medication compliance; neurocognitive test; neurodevelopment; pediatric human immunodeficiency virus; peer; performance tests; perinatal HIV; preventive intervention; processing speed; psychosocial; research study; response; scale up; smartphone Application; tool; transmission process; young adult

There are 2.1 million children with HIV (CWH) under 15 years of age worldwide; the vast majority have perinatally-acquired HIV, reside in resource limited Low-and-Middle Income Countries (LMICs), and are surviving into adolescence and young adulthood. In Uganda, where the proposed study will take place, there are over 130,000 CWH under 15 years. CWH 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 crucial developmental milestones. Neurocognitive impairment (NCI) is chief among these negative effects. NCI in CWH most commonly affects the neurocognitive domains of working memory, executive functions, and processing speed. NCI can affect children’s ability to perform in and complete school, interact successfully with peers and adults, initiate and maintain long-term relationships, and develop independence. 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) for older children and adolescents. The first step in addressing NCI in CWH is detecting it but doing so in Uganda faces numerous challenges. Few neurocognitive tests exist for Ugandan children 5-12 years of age. 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 administered accurately by all levels of staff, researchers and clinicians will remain severely limited in their capacity to assess CWH in Uganda, missing opportunities to study and detect NCI, as well as 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 twelve 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. It has been used successfully with adults and adolescents but has not been evaluated for use with children under 13 years. The proposed study will: (1) determine the necessary adaptations needed to make NeuroScreen usable, understandable, and acceptable to CWH under 13 years, and for HIV providers likely to administer it; (2) generate preliminary estimates of the adapted tests’ validity indicators among CHW and matched controls 5-12 years of age; and (3) explore associations between NeuroScreen performance and behavioral health. These data will be the basis for future larger-scale research studies on NCI, as well as validation, implementation and scale-up of this mHealth tool for use in Uganda and other LMICs.

全球15岁以下的艾滋病毒（CWH）儿童有210万儿童；绝大多数 围产期获得的艾滋病毒，居住在资源有限的低和中间收入国家（LMIC），是 生存到青少年和成年。在拟议的研究将在乌干达，那里 超过130,000 CWH以下15年。 CWH必须与终生病毒感染的负面影响 以及其神经发育，医学状况，心理健康以及许多人的慢性感染 对终身艺术依从性的需求 - 使他们面临未达到关键发展里程碑的风险。 神经认知障碍（NCI）是这些负面影响的主要作用。 CWH中的NCI最常见的影响 工作记忆，执行功能和处理速度的神经认知领域。 NCI会影响 儿童在上学和完成学校的能力，与同龄人和成人成功互动，启动和 保持长期关系并发展独立。 NCI也可能干扰 药物，在艾滋病毒中至关重要，增加决策不良和更大的艾滋病毒传播风险 年龄较大的儿童和青少年的行为（例如，不受保护的性别）。解决CWH中NCI的第一步 正在发现它，但在乌干达这样做面临许多挑战。乌干达很少有神经认知测试 5-12岁的儿童。确实存在的测试需要受过良好训练的人来管理和评分， 需要几个小时的管理，许多人遭受文化偏见的痛苦，因为它们是为了发展而来的 规范在美国或欧洲的青年。没有准确，临床上有用且相对简短的NCI评估 所有级别的员工，研究人员和临床医生都可以准确地管理，这将受到严重限制 以评估乌干达的CWH的能力，缺少学习和检测NCI的机会以及 干预。 Neuroscreen是一个简短，易于使用的应用程序，用于评估NCI的Android设备 由所有级别的临床人员管理。该应用包含十二个评估处理的神经认知测试 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 自动化，需要最少的培训才能进行管理，并且不需要记录保存或评分。它一直 成功与成人和青少年一起使用，但尚未评估13岁以下儿童 年。拟议的研究将：（1）确定使神经锁定可用的必要适应性， 可以理解的，CWH不到13年的CWH，以及可能管理艾滋病毒的提供者； （2） 在CHW和匹配的控件中生成适应性测试的有效性指标的初步估计5-12 年龄； （3）探索神经镜表现与行为健康之间的关联。这些 数据将是对NCI以及验证，实施和实施的未来大规模研究的基础 扩大此MHealth工具，可用于乌干达和其他LMIC。