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

基本信息

批准号：
9900844
负责人：
Reuben N Robbins
金额：
$ 58.95万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-04-01 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9900844
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

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

展开

项目摘要

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）是一种资源有限的环境迅速成为青少年的成千上万的受艾滋病毒感染（PHIV+）青年。 pHIV+ 青少年必须与终身病毒感染和慢性感染对他们的负面影响神经发育，医学状况，心理健康，以及许多人对终身艺术依从性的需求 - 使他们有没有实现这些重要里程碑的风险。神经认知障碍（NCI）是主要的这些负面影响。 pHIV+青少年中的NCI最常影响工作的神经认知领域内存，执行功能和处理速度。 NCI会影响青年的表现和完成的能力学校，与同龄人和成人成功互动，找到就业，建立和维持长期关系，并独立发挥作用。 NCI还可以干扰对艾滋病毒至关重要的药物的依从性，并且增加决策不良和更大的HIV传播风险行为（例如，无保护的性别）。 PHIV+青年在SA中，由于许多社会心理问题，在资源有限设置，例如贫困和教育不良。在PHIV+青少年中解决NCI的第一步是检测并诊断它，但是在南非这样做受到严重阻碍。很少的神经认知测试和筛查在SA中，存在数十万PHIV+青年的测试。 SA中确实存在PHIV+青年的测试需要训练有素的人来管理和评分，需要几个小时来管理，缺乏生态有效性预测现实世界的结果，并且许多人遭受文化偏见的困扰，因为它们是为了发展而来的规范在美国或欧洲的青年。鉴于SA医疗保健系统的负担过高以及其缓解的负担将各种护理的任务转换为外行卫生工作者（LHWS），没有准确，临床上有用，并且相关的简短NC测试，可以检测NCI并满足RLSS，PHIV+青少年中任务转移的需求在SA中将无法评估，缺少检测NCI和干预的机会。 Neuroscreen是一个简短的，易于的将应用程序用于Android设备来评估和筛选NCI，该应用程序旨在由宽阔的范围管理在临床环境中的非专家医疗保健人员范围。该应用包含九个神经认知测试评估处理速度，执行功能，工作记忆，口头记忆和运动速度。这是标准化且高度自动化，需要最少的培训才能进行管理，并且不需要记录 - 保持或得分。拟议的研究将验证神经扫描与SA中的PHIV+青少年一起使用（1）评估其内部有效性，（2）与金标准相比，对检测NCI的灵敏度和特异性神经心理测试电池，（3）在医疗的背景下表征PHIV+青年表现和社会心理因素。该研究还将在13-17之间产生初步的正常绩效数据 SA的年度青少年。像Neuroscreen这样的神经认知评估工具可以轻松修改以供使用在其他依赖任务转移的世界的疾病人群和世界地区。