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A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa

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Abstract

Screening for HIV-associated neurocognitive disorders (HAND) is important to improve clinical outcomes. We compared the diagnostic sensitivity and specificity of the mini-mental state examination, International HIV dementia scale (IHDS), Montreal cognitive assessment, Simioni symptom questionnaire and cognitive assessment tool-rapid version (CAT-rapid) to a gold standard neuropsychological battery. Antiretroviral-experienced participants from Cape Town, South Africa, and Baltimore, USA, were recruited. The sensitivity and specificity of the five tools, as well as those of the combined IHDS and CAT-rapid, were established using 2 × 2 contingency tables and ROC analysis. More than a third (65165) had symptomatic HAND. In detecting HIV-D, the CAT-Rapid had good sensitivity (94 %) and weak specificity (52 %) (cut-point ≤10), while the IHDS showed fair sensitivity (68 %) and good specificity (86 %) (cut-point ≤10). The combined IHDS and CAT-rapid showed excellent sensitivity and specificity for HIV-D at a cut-off score of ≤16 (out of 20; 89 and 82 %). No tool was adequate in screening for any HAND. The combination IHDS and CAT-rapid tool appears to be a good screener for HIV-D but is only fairly sensitive and poorly specific in screening for any HAND. Screening for milder forms of HAND continues to be a clinical challenge.

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Acknowledgments

The authors would like to thank Mr Teboho Linda who conducted the neuro-psychological assessments in Cape Town, South Africa. This work was supported in the USA in part by MH075673.

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Authors and Affiliations

  1. HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Groote Schuur Hospital, Anzio Road, Observatory, 7925, Cape Town, South Africa

    J. A. Joska, C. Robertson & M. Casson-Crook

  2. ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa

    J. Witten & K. G. Thomas

  3. Johns Hopkins University School of Medicine, Baltimore, USA

    H. Roosa, J. Creighton, J. McArthur & N. C. Sacktor

  4. Brigham and Women’s Hospital, Boston, USA

    J. Lyons

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  1. J. A. Joska
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  10. N. C. Sacktor
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Correspondence to J. A. Joska.

Appendix 1: Cognitive Assessment Tool-Rapid Version (CAT-Rapid)1

Appendix 1: Cognitive Assessment Tool-Rapid Version (CAT-Rapid)1

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Joska, J.A., Witten, J., Thomas, K.G. et al. A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa. AIDS Behav 20, 1621–1631 (2016). https://doi.org/10.1007/s10461-016-1316-y

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