Utility of a brief computerized battery to assess HIV-associated neurocognitive impairment in a resource-limited setting
Despite the persistently high prevalence of neurocognitive impairment in HIV-positive patients, routine HIV care in many resource-limited settings does not include neuropsychological assessment. The objective of this study was to examine the utility of a brief computerized battery for identifying neurocognitive impairment in a busy HIV clinic in Uganda. Specifically, we compared performance on a gold standard neuropsychological exam to that on the CogState Brief Battery. In this cross-sectional study, 181 HIV-positive patients completed both assessment batteries in a randomized order. The primary outcome measures were neurocognitive impairment on the standard exam defined by the global deficit score and cumulative performance on the CogState Brief Battery. Sixty-nine participants (38 %) were classified as impaired on the standard neuropsychological exam, and participants who were classified as impaired performed significantly worse on CogState compared to those who were unimpaired (p < 0.001). CogState had adequate specificity but low sensitivity, suggesting that it may not be a clinically useful screening tool to identify patients who likely have neurocognitive impairment in Uganda. This study supports the feasibility of using a computerized battery for assessing neurocognitive impairment in HIV-positive patients in resource-limited settings, but additional research is needed to identify screening tools with higher sensitivity for use in HIV clinics.
KeywordsHIV/AIDS NeuroAIDS Neurocognitive impairment Africa Computerized assessment
This study was completed while the primary author (NY) was a master’s student at the Duke Global Health Institute. The authors wish to thank the following: Dr. Nixon Niyonzima for his assistance in obtaining IRB approval at Makere University and Charles Kasujja and Sophia Nakiwala for their assistance in patient recruitment and evaluations. SLT was supported by NIAID T32-AI007392 (Thielman). DW was supported by NIAID P30-AI-064518 (Weinhold). CSM was supported by NIDA K23-DA-028660 (Meade). NY was supported by a research grant from the Duke Global Health Institute.
Compliance with ethical standards
Ethical approval was obtained from Duke University School of Medicine, the Infectious Disease Clinic at Mulago Hospital, and Makerere University. The participants provided written informed consent in English prior to any study-related activities.
Conflicts of interest
The authors declare that they have no conflict of interest.
Conceived and designed the experiments: NY, NN, KRR, and CSM. Performed patient evaluations: NY. Analyzed the data: NY and ST under the close guidance of DW and CSM. Wrote the paper: NY, ST, DW, NN, KRR, and CSM.
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