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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

Miriam C. Chernoff
1   Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
,
Barbara Laughton
2   Family Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, RSA, South Africa
,
Mmule Ratswana
3   Wits Reproductive Health & HIV Institute (WRHI), Shandukani Clinic, Johannesburg, RSA, South Africa
,
Itziar Familiar
4   Department of Psychiatry, Michigan State University, East Lansing, Michigan, United States
,
Lee Fairlie
3   Wits Reproductive Health & HIV Institute (WRHI), Shandukani Clinic, Johannesburg, RSA, South Africa
,
Tichaona Vhembo
5   Harare Family Care CRS, University of Zimbabwe, College of Health Sciences Clinical Trials Unit, Harare, Zimbabwe
,
Portia Kamthunzi
6   University of North Carolina Project– Lilongwe, Malawi CRS, Malawi
,
Enid Kabugho
7   Makerere University-Johns Hopkins University Research Collaboration (MUJHU CARE LTD) CRS, Kampala, Uganda
,
Celeste Joyce
8   University of Witwatersrand, RSA, Perinatal HIV Research Unit, Soweto RSA, South Africa
,
Bonnie Zimmer
9   Frontier Science Foundation, Amherst, New York, United States
,
J. L. Ariansen
10   Clinical Research Management, FHI360, Durham, North Carolina, United States
,
Patrick Jean-Philippe
11   Maternal Adolescent Pediatric Research Branch, DAIDS/NIAID/NIH, Rockville, Maryland, United States
,
Michael J. Boivin
4   Department of Psychiatry, Michigan State University, East Lansing, Michigan, United States
12   Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, United States
13   Department of Psychiatry, the University of Michigan, Ann Arbor, Michigan, United States
› Author Affiliations
Further Information

Publication History

03 October 2017

06 February 2018

Publication Date:
20 March 2018 (online)

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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

Supplementary Material

 

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