Neurodevelopmental screening in children born to HIV-infected mothers in Kenya

肯尼亚艾滋病毒感染母亲所生儿童的神经发育筛查

• 批准号: 9789944
• 负责人: Megan Song McHenry
• 金额: $ 18.12万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-21 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789944
• 关键词: Africa South of the Sahara; Area; Assessment tool; Brain; Caring; Child; Child Care; Child Health; Childhood; Clinic; Clinical; Communities; Cost Effectiveness Analysis; Data; Development; Diagnosis; Early identification; Effectiveness; Evaluation; Faculty; Future; Goals; HIV; Health; Healthcare Systems; Human; Infant; Intake; Intervention; Kenya; Knowledge; Malawi; Measures; Mentorship; Methodology; Mission; Modeling; Monitor; Mothers; Outcome; Population; Predictive Value; Pregnant Women; Program Evaluation; Property; Psychologist; Psychometrics; Public Health; Questionnaires; Reference Standards; Research; Research Activity; Research Infrastructure; Research Personnel; Resources; Risk; Screening procedure; Sensitivity and Specificity; Service delivery model; Services; Site; System; Tern; Testing; Toddler; United States National Institutes of Health; Validity and Reliability; Vulnerable Populations; Work; aged; care systems; career; combat; community based participatory research; cost; diagnostic accuracy; disability; effective intervention; health care availability; implementation research; implementation science; implementation strategy; improved; innovation; instrument; intervention program; multidisciplinary; neurodevelopment; pediatric human immunodeficiency virus; programs; scale up; screening; screening program; service intervention; standardize measure; tool

PROJECT SUMMARY Children born to HIV-infected mothers are more likely to have neurodevelopmental (ND) delays than HIV- unexposed children. Early identification and referral to intervention services is critical to improve the lives of children with ND delays, but it is not routinely performed in HIV-prevalent areas, such as sub-Saharan Africa. This is a critical missed opportunity for the >1 million children born to HIV-infected mothers annually. Integrating sustainable ND evaluation programs, with screening, assessment, and intervention services, is critically needed within clinical systems caring for children born to HIV-infected mothers. The long-term goal is to implement an effective ND screening and intervention program to combat ND delays in children born to HIV-infected mothers in resource-limited settings. The overall objectives of this application are: (1) to identify appropriate ND instruments for use in HIV-exposed Kenyan children and (2) to pilot an integrated ND screening program within the existing care system. The central hypothesis is that the integration of a ND evaluation program using appropriate tools will be feasible and effective at identifying HIV-exposed children with ND delays in Kenya. These objectives will be achieved by pursuing the following specific aims: 1) Determine and compare the reliability and validity of ND screening tools and assessments for use among children aged 18-36 months in Kenya and 2) Evaluate ND screening implementation in an existing health care system in Kenya. Under the first aim, a rigorous cross-cultural adaptation will be performed, and psychometric properties of two ND screening tools and two assessments will be evaluated among 240 Kenyan children. This will identify an optimal screening tool and assessment for the setting. Under the second aim, an implementation plan will be developed using principles of community-based participatory research and implementation science. An ND screening program will then be piloted at one clinic in Kenya. Within this pilot, the following implementation outcomes will be measured: acceptability, feasibility, fidelity, implementation cost, and sustainability. The diagnostic accuracy of ND screening at identifying ND delays will also be determined. This study is significant because of its potential to sustainably improve the neurodevelopment of HIV-exposed children by: 1) identifying HIV-exposed children with ND delays and referring them to therapy and 2) creating a research platform to support the evaluation of innovative interventions and track longitudinal outcomes. The proposed research is innovative because a sustainable ND screening program will be created and integrated within the current model of care. This will provide preliminary data for a cost-effectiveness analysis of a larger scale-up of implementation. An integrated, sustainable ND screening program will identify and treat children with ND delays and create a research platform to evaluate future interventions for ND delays.

项目摘要 与艾滋病毒相比 未暴露的孩子。早期识别和转介干预服务对于改善生活至关重要 ND延迟的孩子，但在艾滋病毒降低的地区（例如撒哈拉州），它并不常规地进行 非洲。对于每年受艾滋病毒感染的母亲出生的> 100万儿童来说，这是一个关键的错过机会。 将可持续性ND评估计划与筛查，评估和干预服务整合在一起是 在临床系统中需要关注艾滋病毒感染的母亲所生的儿童。长期 目标是实施有效的ND筛查和干预计划，以打击儿童的延误 在资源有限的环境中生于艾滋病毒感染的母亲。此应用程序的总体目标是：（1） 识别适当的ND仪器，用于艾滋病毒暴露的肯尼亚儿童，（2）试行综合 现有护理系统中的ND筛查计划。中心假设是 使用适当工具的ND评估程序可行，有效地识别艾滋病毒暴露 肯尼亚有ND延误的孩子。这些目标将通过追求以下特定而实现 目的：1）确定和比较ND筛选工具和评估的可靠性和有效性 在肯尼亚18-36个月的儿童中，2）评估现有的筛查实施 肯尼亚的医疗保健系统。在第一个目标下，将进行严格的跨文化适应 240中将评估两个ND筛查工具和两种评估的心理测量特性 肯尼亚儿童。这将确定设置的最佳筛选工具和评估。在 第二个目的，将使用基于社区的参与性的原则制定实施计划 研究与实施科学。然后，将在肯尼亚的一家诊所进行筛查计划。 在该飞行员中，将测量以下实施结果：可接受性，可行性，忠诚度， 实施成本和可持续性。识别ND延迟时ND筛查的诊断准确性 也将确定。这项研究很重要，因为它有潜力可持续地改善 艾滋病毒暴露儿童的神经发育作者：1）识别患有ND延迟的艾滋病毒暴露儿童 将他们参考治疗和2）创建一个研究平台来支持创新的评估 干预和跟踪纵向结果。拟议的研究具有创新性，因为可持续 ND筛选程序将创建并集成到当前护理模型中。这将提供 对更大规模实施的成本效益分析的初步数据。一个综合的， 可持续ND筛查计划将识别和治​​疗儿童ND延迟并创建研究 评估ND延迟的未来干预措施的平台。