Enhancing Research for Inflammation and Cognitive Health in Perinatally Acquired HIV (ENRICH PHIV)

加强围产期艾滋病毒炎症和认知健康研究 (ENRICH PHIV)

• 批准号: 10260545
• 负责人: Reuben N Robbins
• 金额: $ 22.2万
• 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: 2020
• 资助国家: 美国
• 起止时间: 2020-09-09 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10260545
• 关键词: 15 year old; Address; Adherence; Adolescence; Adult; Affect; Air Pollution; Attention; Behavioral; Biological Assay; Biological Markers; Blood Vessels; Blood specimen; Brain; Cardiovascular Diseases; Characteristics; Child; Chronic; Clinic; Clinical; Clinical Research; Cognitive; Community Health Aides; Data; Decision Making; Development; Devices; Diagnosis; Disease; Early-life trauma; Employment; Ensure; Environmental Risk Factor; Europe; Face; FarGo; Future; HIV; Health; Health Personnel; Hour; Human Resources; Impairment; Individual; Inflammation; Inflammatory; Infrastructure; Institution; Joints; Language; Learning; Life; Malaria; Measures; Medical; Medical Research; Memory; Mental Health; Microprocessor; Motor; Neurocognition; Neurocognitive; Neurocognitive Deficit; Neuropsychological Tests; Nurses; Outcome; Paper; Pathway interactions; Patients; Performance; Perinatal; Pharmaceutical Preparations; Population; Poverty; Process; Psychologist; Psychometrics; Public Health; Research; Research Personnel; Resources; Risk; Risk Behaviors; Schools; Sensitivity and Specificity; Short-Term Memory; South Africa; South African; Speed; Standardization; Structural defect; Tablet Computer; Tablets; Testing; Thailand; Time; Training; Translations; Tuberculosis; Uganda; Universities; Unsafe Sex; Validation; Viral; Virus Diseases; Visuospatial; Water; Youth; base; co-infection; cost; design; executive function; immune activation; improved; inflammatory marker; low and middle-income countries; mHealth; medication compliance; neurocognitive test; neurodevelopment; peer; portability; preventive intervention; processing speed; psychosocial stressors; research study; response; 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 have perinatally acquired HIV (PHIV), 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 children under 15 years living with HIV, the vast majority with PHIV, and tens of thousands more living with PHIV over 15 years. Youth with PHIV 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 tests exist for Ugandan youth with PHIV. 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 staff, researchers and clinicians will be severely limited in their capacity to assess youth with PHIV 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 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 Uganda and Luganda-speaking populations youth with PHIV and evaluated the adapted NeuroScreen’s usability and acceptability among Ugandan youth with PHIV and clinical staff; (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 (3) explore associations between NeuroScreen performance and markers of inflammation and immune activation. These data will be the basis for future larger-scale research studies on NCI and inflammation, as well as validation, implementation and scale-up of this mHealth tool for use in Uganda and other LMICs.

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感染者； 感染艾滋病毒 (PHIV)，居住在资源有限的中低收入国家 (LMIC)，并且正在存活 拟议的研究将在乌干达进行，直到青春期和成年初期。 130,000 名 15 岁以下儿童感染艾滋病毒，其中绝大多数感染艾滋病毒，还有数以万计的儿童感染艾滋病毒 感染 PHIV 超过 15 年的青少年必须应对终生病毒感染的负面影响，并且 慢性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， 终生坚持 ART——使他们面临无法实现这些重要神经认知里程碑的风险。 损伤 (NCI) 是 PHIV 青少年中最主要的负面影响。 工作记忆、执行功能和处理速度的神经认知领域会影响青少年的能力。 能够在学校表现并完成学业、与同龄人和成年人成功互动、找到工作、启动 维持长期关系和独立运作也会干扰遵守。 药物治疗对艾滋病毒至关重要，并且会增加决策失误和艾滋病毒传播风险 解决 PHIV 青少年 NCI 问题的第一步是检测和诊断。 但在泰国这样做面临着许多挑战，乌干达青少年的神经认知测试很少。 确实存在的 PHIV 测试需要训练有素的人员进行管理和评分，需要几个小时才能完成。 管理，许多人遭受文化偏见，因为它们是为年轻人开发的，并以年轻人为规范 美国或欧洲没有准确、有临床意义且相对简短的 NCI 评估。 各级工作人员、研究人员和信徒的管理能力将受到严重限制 乌干达感染 PHIV 的青少年失去了研究和检测 NCI 以及进行 NeuroScreen 干预的机会。 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，旨在由所有人管理 该应用程序包含十项神经认知测试，评估处理速度、执行力。 它是标准化且高度自动化的。 需要最少的管理培训，并且不需要记录或评分。 将： (1) 针对乌干达和卢干达语人群感染 PHIV 的青少年调整 NeuroScreen，并评估 调整了 NeuroScreen 在感染艾滋病病毒的乌干达青年和临床工作人员中的可用性和可接受性 (2) (3) 检验适应性 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 (3) 探索 NeuroScreen 性能与炎症和免疫激活标志物之间的关联。 数据将成为未来更大规模的 NCI 和炎症研究以及验证的基础， 实施并扩大这一移动医疗工具在乌干达和其他中低收入国家的使用。