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

利用移动技术改进资源有限环境下围产期艾滋病毒感染青少年的神经认知障碍评估

• 批准号: 9794131
• 负责人: Reuben N Robbins
• 金额: $ 16.76万
• 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: 2018-09-30 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9794131
• 关键词: 15 year old; Address; Adherence; Adolescence; Adolescent and Young Adult; Adult; Affect; Asians; Behavioral; Brain; Characteristics; Child; Chronic; Clinic; Clinical; Clinical assessments; Country; Cross-Cultural Comparison; Data; Decision Making; Development; Devices; Diagnosis; Disease; Employment; Ensure; Etiology; Europe; Exposure to; Face; Future; Gold; HIV; HIV Infections; HIV-infected adolescents; Health; Healthcare; Hour; Human Resources; Impairment; Individual; Inflammation; Infrastructure; Language; Learning; Life; Linguistics; Measures; Medical; Medical Research; Memory; Mental Health; Microprocessor; Motor; Neurocognitive; Neurocognitive Deficit; Neuropsychological Tests; Nurses; Outcome; Paper; Pathway interactions; Patients; Performance; Pharmaceutical Preparations; Population; Preventive Intervention; Process; Provider; Psychologist; Psychometrics; Public Health; Reaction Time; Research; Research Personnel; Resources; Risk; Risk Behaviors; Schools; Sensitivity and Specificity; Short-Term Memory; Social Workers; South Africa; South African; Speed; Standardization; Structural defect; Tablet Computer; Tablets; Testing; Thailand; Training; Translations; Unsafe Sex; Validation; Viral Load result; Virus Diseases; Work; Youth; base; behavioral health; cohort; computerized; cost; design; executive function; improved; low and middle-income countries; mHealth; medication compliance; mobile computing; neurocognitive test; neurodevelopment; neuroimaging; operation; peer; perinatal HIV; portability; processing speed; psychosocial; resilience; scale up; screening; smartphone Application; tool; touchscreen; transmission process; usability; young adult

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.

全球有 210 万 0-15 岁儿童感染艾滋病毒，其中绝大多数是围产期儿童； HIV 感染者 (PHIV) 居住在资源有限的中低收入国家 (LMIC)，并且正在存活 在泰国，拟议的研究将在青少年和青年期进行。 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 (PHIV) 的青少年 艾滋病毒青少年必须应对终生病毒感染和慢性病的负面影响。 炎症会影响他们的神经发育、医疗状况、心理健康，以及对许多人来说，终生的需求 ART 依从性——使他们面临无法实现这些重要里程碑的风险。 (NCI) 是 PHIV 青少年中最主要的负面影响，最常影响神经认知。 工作记忆、执行功能和处理速度等领域会影响青少年的执行能力。 在校并完成学业，与同龄人和成年人成功互动，找到工作，启动和维持 长期关系和独立功能也会干扰药物治疗的依从性。 在艾滋病毒中至关重要，并会增加糟糕的决策和更大的艾滋病毒传播风险行为（例如， 解决青少年 PHIV 中 NCI 问题的第一步是检测和诊断，但要在以下时间进行： 泰国面临着众多挑战。针对泰国艾滋病病毒感染者青少年的神经认知筛查测试很少。 确实存在，需要训练有素的人员来管理和评分，需要几个小时来管理，并且 许多人都受到文化偏见的困扰，因为它们是为美国或欧洲的年轻人开发并以他们为规范的。 缺乏可以准确实施的准确、有临床意义且相对简短的 NCI 评估 各级临床工作人员不会对泰国的 PHIV 青少年进行评估，错失检测 NCI 的机会 NeuroScreen 是一款简短、易于使用的应用程序，适用于 Android 设备，用于评估 NCI 该应用程序旨在由各级临床工作人员进行管理，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都是标准化的。 并且高度自动化，需要最少的管理培训，并且不需要保存记录或 拟议的研究将：(1) 针对泰国和泰语 PHIV 人群调整 NeuroScreen。 青年；(2) 对改编后的测试的有效性指标进行初步估计；(3) 检查改编后的测试； NeuroScreen 在泰国 PHIV 青少年和临床工作人员中的可用性和可接受性；以及 (4) 探索 NeuroScreen 表现与医疗（病毒载量）、行为健康、ART 之间的关联 这些数据将成为未来更大规模研究的基础。 验证实施以及扩大该移动医疗工具在泰国和其他中低收入国家的使用。 NeuroScreen 可以轻松修改以用于其他疾病和依赖任务转移的中低收入国家 到有限的医疗资源。