title: Utility of a brief computerized battery to assess HIV-associated neurocognitive impairment in a resource-limited setting.
abstract: Despite the persistently high prevalence of neurocognitive impairment in HIV-positive patients, routine HIV care in many resource-limited settings does not include neuropsychological assessment. The objective of this study was to examine the utility of a brief computerized battery for identifying neurocognitive impairment in a busy HIV clinic in Uganda. Specifically, we compared performance on a gold standard neuropsychological exam to that on the CogState Brief Battery. In this cross-sectional study, 181 HIV-positive patients completed both assessment batteries in a randomized order. The primary outcome measures were neurocognitive impairment on the standard exam defined by the global deficit score and cumulative performance on the CogState Brief Battery. Sixty-nine participants (38 %) were classified as impaired on the standard neuropsychological exam, and participants who were classified as impaired performed significantly worse on CogState compared to those who were unimpaired (p < 0.001). CogState had adequate specificity but low sensitivity, suggesting that it may not be a clinically useful screening tool to identify patients who likely have neurocognitive impairment in Uganda. This study supports the feasibility of using a computerized battery for assessing neurocognitive impairment in HIV-positive patients in resource-limited settings, but additional research is needed to identify screening tools with higher sensitivity for use in HIV clinics.
authors.affiliation: Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA.|The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.
authors.forename: Nirupama
authors.initials: N
authors.lastname: Yechoor
authors.affiliation: Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA.|Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27708, USA.
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Towe
authors.affiliation: Department of Neurology, Physicians Office Building, 170 Manning Drive, UNC-Chapel Hill, Chapel Hill, NC, 27599, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Robertson
authors.affiliation: Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA.|Department of Epidemiology, CB 7435 McGavran-Greenberg Hall, UNC-Chapel Hill, Chapel Hill, NC, 27599, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Westreich
authors.affiliation: Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Noeline
authors.initials: N
authors.lastname: Nakasujja
authors.affiliation: Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA. christina.meade@duke.edu.|Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27708, USA. christina.meade@duke.edu.
authors.forename: Christina S
authors.initials: CS
authors.lastname: Meade
mesh_terms: D000328:Adult; D060825:Cognitive Dysfunction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014454:Uganda
keywords: Africa; Computerized assessment; HIV/AIDS; NeuroAIDS; Neurocognitive impairment