HIV-associated neurocognitive disorders in sub-Saharan Africa: a pilot study in Cameroon

Background: People living with HIV are at risk of developing HIV-associated neurocognitive disorders (HAND) which adversely affects their quality of life. Routine screening of HAND in HIV care is recommended to identify clinically important changes in cognitive functioning and allow for early interventions. However, HAND detection in routine clinical practice has never been reported in sub-Saharan Africa (SSA), partly due to a lack of adequately standardized screening tools. This review was conducted to identify the commonly used screening tools for HAND in SSA and document their psychometric properties and diagnostic accuracy. Methods: We searched Ovid Medline, PsycINFO and Web of Sciences databases for empirical studies published from 1/1/1980 to 31/8/2018 on HAND among adults living with HIV in SSA. Results: We identified 14 eligible studies, of which 9 were from South Africa. The International HIV Dementia Scale (IHDS) was the most frequently reported tool, being used in more than half of the studies. However most studies only reported the diagnostic accuracy of this and other tools, with specificity ranging from 37% to 81% and sensitivity ranging from 45% to 100%. Appropriate data on construct validity and reliability of tools was rarely documented. Although most tools performed well in screening for severe forms of HAND, they lacked sensitivity and specificity for mild forms of HAND. NeuroScreen, one of the newer tools, yielded good diagnostic accuracy in its initial evaluation in South Africa (81% to 93% sensitivity and 71% to 81% specificity). Conclusions: This review identified a lack of adequately standardized and contextually relevant HAND screening tools in SSA. Most screening tools for HAND used in SSA possess inadequate psychometric properties and diagnostic accuracy. There is a need for further validation of existing tools and development of new HAND screening tools in SSA.

Download Full-text

Screening tools for HIV-associated neurocognitive disorders among adults living with HIV in sub-Saharan Africa: A scoping review

AAS Open Research ◽

10.12688/aasopenres.12921.1 ◽

2018 ◽

Vol 1 ◽

pp. 28 ◽

Cited By ~ 1

Author(s):

Patrick N. Mwangala ◽

Charles R. Newton ◽

Melanie Abas ◽

Amina Abubakar

Keyword(s):

South Africa ◽

Diagnostic Accuracy ◽

Psychometric Properties ◽

Neurocognitive Disorders ◽

Screening Tools ◽

Sub Saharan Africa ◽

Hiv Care ◽

Sub Saharan ◽

Living With Hiv ◽

Hiv Associated Neurocognitive Disorders

Background: People living with HIV are at risk of developing HIV-associated neurocognitive disorders (HAND) which adversely affects their quality of life. Routine screening of HAND in HIV care is recommended to identify subtle changes in cognitive functioning and allow for early interventions. However, HAND detection is rarely done in sub-Saharan Africa (SSA), partly due to a lack of adequately standardized screening tools. This review was conducted to identify the commonly used screening tools for HAND in SSA and document their psychometric properties and diagnostic accuracy.Methods:We searched Ovid Medline, PsycINFO and Web of Sciences databases for empirical studies published from 1/1/1980 to 31/8/2018 on HAND among adults living with HIV in SSA.Results:We identified 14 eligible studies, of which 9 were from South Africa. The International HIV Dementia Scale (IHDS) was the most frequently reported tool, being used in more than half of the studies. However most studies only reported the diagnostic accuracy of this and other tools, with specificity ranging from 37% to 81% and sensitivity ranging from 45% to 100%. Appropriate data on construct validity and reliability of tools was rarely documented. Although most tools performed well in screening for severe forms of HAND, they lacked sensitivity and specificity for moderate forms of HAND. NeuroScreen, one of the newer tools, yielded good diagnostic accuracy in its initial evaluation in South Africa (81% to 93% sensitivity and 71% to 81% specificity).Conclusions:This review identified a lack of adequately standardized and contextually relevant HAND screening tools in SSA. Most screening tools for HAND used in SSA possess inadequate psychometric properties and diagnostic accuracy. There is a need for further validation of existing tools and development of new tools to make them sensitive and specific enough to identify both severe and moderate forms of HAND in SSA.

Download Full-text

HIV-Associated Neurocognitive Disorders (HAND): The First Longitudinal Follow Up of a cART-Treated Cohort of Older People in Sub-Saharan Africa

SSRN Electronic Journal ◽

10.2139/ssrn.3839449 ◽

2021 ◽

Author(s):

Rebecca Spooner ◽

Sherika Ranasinghe ◽

Sarah Urasa ◽

Marcella Yoseph ◽

Sengua Koipapi ◽

...

Keyword(s):

Older People ◽

Neurocognitive Disorders ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Hiv Associated Neurocognitive Disorders

Download Full-text

The HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) Study: Pro- tocol of a Research Program in Pediatric HIV in Sub-Saharan Africa

10.17303/jaid.2019.5.103 ◽

2019 ◽

Keyword(s):

Research Program ◽

Neurocognitive Disorders ◽

Pediatric Hiv ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Hiv Associated Neurocognitive Disorders

Download Full-text

Feasibility and acceptability of financial incentives and peer-led life skills training for improving adherence to antiretroviral therapy among adolescents living with HIV in Rwanda: A pilot study

10.21203/rs.3.rs-23345/v1 ◽

2020 ◽

Author(s):

Majdi Osman ◽

Simon Pierre Niyonsenga ◽

Manasi Sharma ◽

Rebecca Hope ◽

Shannon Milroy ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Pilot Study ◽

Financial Incentives ◽

Life Skills ◽

Skills Training ◽

Sub Saharan Africa ◽

Hiv Care ◽

Art Adherence ◽

Life Skills Training ◽

Sub Saharan

Abstract Background The Human Immunodeficiency Virus (HIV) is the leading cause of death among adolescents in sub-Saharan Africa. Despite the long-term benefits of antiretroviral therapy (ART), adherence remains low among adolescents due to challenges related to cost, acquisition, and treatment regimen. Sub-optimal adherence to ART is associated with the development of viral resistance, treatment failure, and increased morbidity and mortality. Financial incentives and life skills training interventions have shown early promise in motivating protective behaviors, however, gaps still remain around effective and innovative ways to motivate adolescents to stay in HIV care. In partnership with youth, we developed an intervention to address their social and financial pressures in order to promote adherence. Methods A human-centered design approach was utilized to engage adolescents in the initial design of the intervention. Through random sampling, 72 adolescents ages 12–19 were then recruited from two clinics in Rwanda for the pilot study. Adolescents participated in three monthly peer-led life skills trainings at clinics and received financial incentives via mobile money upon clinic attendance and demonstration of suppressed viral load. Semi-structured interviews were then conducted with adolescents, healthcare workers, and caregivers to understand their experiences with the intervention. Results Participants responded favorably to the intervention because of the psychosocial, financial, and health benefits it provided. Caregivers felt that adolescents’ moods, attitudes, and overall well-being improved over time. Adolescents used funds to purchase school supplies and save for investments, thus mitigating their financial burdens. Additionally, we learned that logistical challenges such as SIM card registration and mobile phone access must be considered for scale-up of the intervention. Conclusions To our knowledge, this is the first intervention designed in partnership with youth in sub-Saharan Africa aimed at removing financial barriers to ART adherence. The findings suggest that involving youth in the design of programs, providing them with financial incentives, and training them to use and invest their money wisely has a positive effect on them and their families. Thus, to improve adherence to ART and retention in care among HIV-positive youth, it is critical to address their socioeconomic and psychosocial needs.

Download Full-text