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