title: Closing gaps in antiretroviral therapy access: human immunodeficiency virus-associated dementia screening instruments for non-physician healthcare workers.
abstract: Human immunodeficiency virus-associated dementia (HIV-D) is an indication for antiretroviral therapy (ART), but HIV-D is not routinely screened for in ART clinics in sub-Saharan Africa. Given the dearth of physicians in sub-Saharan Africa, enabling non-physician healthcare workers to identify HIV-D is crucial for early treatment initiation and preventing chronic neurologic disability. Non-physician healthcare workers administered locally adapted screening instruments to 48 persons living with acquired immunodeficiency syndrome (PLWAs), and 15 healthy comparison persons provided normative data. Stage IV PLWAs performed worse than the comparison group on all tests. Overall, 24 (50%) of 48 PLWAs had significant cognitive impairment. Among HIV staging categories, 1 stage II (33%), 6 stage III (42%), and 17 stage IV (55%) patients were identified as cognitively impaired. Our pilot study indicates that screening instruments used by non-physician healthcare workers can identify cognitive impairment in PLWAs and may facilitate appropriate initiation of ART in resource-poor settings.
authors.affiliation: International Neurologic and Psychiatric Epidemiology Program, and College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan 48824, USA.
authors.forename: Michelle P
authors.initials: MP
authors.lastname: Kvalsund
authors.forename: Alan
authors.initials: A
authors.lastname: Haworth
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Murman
authors.forename: Ellen
authors.initials: E
authors.lastname: Velie
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Birbeck
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D010865:Pilot Projects; D015024:Zambia / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents