Validity of Neuropsychological Testing in Young African Children Affected by HIV

Miriam C. Chernoff; Barbara Laughton; Mmule Ratswana; Itziar Familiar; Lee Fairlie; Tichaona Vhembo; Portia Kamthunzi; Enid Kabugho; Celeste Joyce; Bonnie Zimmer; J. L. Ariansen; Patrick Jean-Philippe; Michael J. Boivin

doi:10.1055/s-0038-1637020

Journal of Pediatric Infectious Diseases, Inhaltsverzeichnis

J Pediatr Infect Dis 2018; 13(03): 185-201
DOI: 10.1055/s-0038-1637020

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Validity of Neuropsychological Testing in Young African Children Affected by HIV

Authors

Miriam C. Chernoff

¹Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
Barbara Laughton

²Family Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, RSA, South Africa
Mmule Ratswana

³Wits Reproductive Health & HIV Institute (WRHI), Shandukani Clinic, Johannesburg, RSA, South Africa
Itziar Familiar

⁴Department of Psychiatry, Michigan State University, East Lansing, Michigan, United States
Lee Fairlie

³Wits Reproductive Health & HIV Institute (WRHI), Shandukani Clinic, Johannesburg, RSA, South Africa
Tichaona Vhembo

⁵Harare Family Care CRS, University of Zimbabwe, College of Health Sciences Clinical Trials Unit, Harare, Zimbabwe
Portia Kamthunzi

⁶University of North Carolina Project– Lilongwe, Malawi CRS, Malawi
Enid Kabugho

⁷Makerere University-Johns Hopkins University Research Collaboration (MUJHU CARE LTD) CRS, Kampala, Uganda
Celeste Joyce

⁸University of Witwatersrand, RSA, Perinatal HIV Research Unit, Soweto RSA, South Africa
Bonnie Zimmer

⁹Frontier Science Foundation, Amherst, New York, United States
J. L. Ariansen

¹⁰Clinical Research Management, FHI360, Durham, North Carolina, United States
Patrick Jean-Philippe

¹¹Maternal Adolescent Pediatric Research Branch, DAIDS/NIAID/NIH, Rockville, Maryland, United States
Michael J. Boivin

⁴Department of Psychiatry, Michigan State University, East Lansing, Michigan, United States

¹²Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, United States

¹³Department of Psychiatry, the University of Michigan, Ann Arbor, Michigan, United States

Abstract

Introduction Western-constructed neuropsychological tests have been used in low- and middle-income countries to assess the impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and other chronic illnesses. We explore using such instruments cross-culturally in a sub-Saharan African setting.

Methods IMPAACT P1104S was a 2-year observational study performed at six clinical sites (South Africa—three sites, Malawi, Uganda, and Zimbabwe) to assess and compare neuropsychological outcomes in three cohorts of children between the ages of 5 and 11 years: HIV-infected (HIV), HIV-exposed but uninfected (HEU), and HIV unexposed and uninfected (HU). Descriptive statistics compared sociodemographic characteristics among children at sites. Instruments included the Kaufman Assessment Battery for Children, 2nd edition (KABC-II) cognitive ability, Test of Variables of Attention (TOVA) attention/impulsivity, Bruininks–Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2) motor proficiency tests, and Behavior Rating Inventory for Executive Function (BRIEF) executive function problems. Test characteristics were assessed using intraclass and Spearman's nonparametric correlations, linear regression, and principal factor analyses.

Results Of the 611 participants, 50% were males and mean age ranged from 6.6 to 8 years. In Malawi, Uganda, and Zimbabwe, substantial proportions of families lived in rural settings in contrast to the South African sites. Intraclass correlation coefficients between weeks 0 and 48 were highest for the KABC scores, ranging between 0.42 and 0.71. Correlations among similar test domains were low to moderate but significant, with positive correlation between KABC sequential and TOVA scores and negative correlation between BRIEF and KABC scores. TOVA response time scores correlated negatively with the BOT-2 total points score. Strong and significant associations between individual measures of growth, disability, and development with all test scores were observed. Performance-based measures were markedly lower for HIV compared with HEU and HU participants, even after controlling for age, sex, and site. Factor analyses confirmed the underlying theoretical structure of the KABC scaled item scores.

Conclusion The KABC, TOVA, BRIEF, and BOT-2 were valid and reliable tools for assessing the neuropsychological impact of HIV in four sub-Saharan African countries.

Keywords

pediatric HIV - neuropsychological testing - validity - reliability - Africa

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Referenzen

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