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Zondo S, Cockcroft K, Ferreira-Correia A. Brain plasticity and adolescent HIV: A randomised controlled trial protocol investigating behavioural and hemodynamic responses in attention cognitive rehabilitation therapy. MethodsX 2024; 13:102808. [PMID: 39022176 PMCID: PMC11252933 DOI: 10.1016/j.mex.2024.102808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Despite advances in antiretroviral pharmacology, neuroHIV in the central nervous system (CNS), causes neuronal dysregulation, which is associated with compromised neurocognition. Non-pharmaceutical interventions such as HIV cognitive rehabilitation training (HIV-CRT), have shown potential to partially reverse cognitive deficits, sequent HIV neuroinvasion. Nonetheless, no studies exist pairing cognitive outcomes with objective neuroimaging biomarkers in adolescent HIV-CRT. This longitudinal pre-post-quasi-experimental protocol examined cognitive outcomes, paired with optimal neuroimaging outcomes following customised attention training in adolescent HIV. Twenty-six adolescents living with HIV were randomly assigned to either the treatment group, which received attention CRT using ACTIVATE™, (n = 13), or to the treatment as usual group (n = 13). Cognitive outcomes were examined using the NEPSY-II, and BRIEF; whilst neuroimaging outcomes were determined by changes in oxygenated haemoglobin (HbO), as determined by functional near-infrared spectrometry (fNIRS). Functional connectivity fNIRS measures were evaluated using seed-based correlation analysis, located in the central executive network (CEN). This study serves to guide the development and identification of objective biomarkers for adolescent neuroHIV, sequent CRT amongst children living with HIV in Sub-Saharan Africa.
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Affiliation(s)
- Sizwe Zondo
- Department of Psychology, Rhodes University, 1 University Road, Grahamstown 6139, South Africa
- Department of Psychology, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg 2000, South Africa
| | - Kate Cockcroft
- Department of Psychology, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg 2000, South Africa
| | - Aline Ferreira-Correia
- Department of Psychology, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg 2000, South Africa
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Mrakotsky C, Walsh KS, Buranahirun Burns C, Croteau SE, Markert A, Geybels M, Hannemann C, Rajpurkar M, Shapiro KA, Wilkening GN, Ventola P, Cooper DL. The eTHINK Study: Cognitive and Behavioral Outcomes in Children with Hemophilia. J Pediatr 2024; 272:114089. [PMID: 38734133 DOI: 10.1016/j.jpeds.2024.114089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/12/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To assess cognitive, behavioral, and adaptive functions in children and young adults with hemophilia treated according to contemporary standards of care. STUDY DESIGN Evolving Treatment of Hemophilia's Impact on Neurodevelopment, Intelligence, and Other Cognitive Functions (eTHINK) is a US-based, prospective, cross-sectional, observational study (September 2018 through October 2019). Males (aged 1-21 years) with hemophilia A or B of any severity, with or without inhibitors, were eligible. Participants underwent neurologic examinations and age-appropriate neuropsychological assessments, including standardized tests/ratings scales of early development, cognition, emotional/behavioral adjustment, and adaptive skills. RESULTS Five hundred and fifty-one males with hemophilia A (n = 433) or B (n = 101) were enrolled. Performance on cognitive tests was largely comparable with that of age-matched US population norms, although participants in certain age groups (4-5 and 10-21 years) performed worse on measures of attention and processing speed. Furthermore, adolescents and young adults and those with comorbid attention-deficit/hyperactivity disorder (ADHD; n = 64) reported more adaptive and executive function problems in daily life. Incidence of ADHD in adolescents (21%) was higher than expected in the general population. CONCLUSIONS In general, males with hemophilia demonstrated age-appropriate intellectual, behavioral, and adaptive development. However, specific patient/age groups showed poorer attention performance and concerns for executive and adaptive development. This study established a normative data set for monitoring neurodevelopment in individuals with hemophilia and highlight the importance of screening and intervention for challenges with cognitive and adaptive skills in this population. CLINICAL TRIAL REGISTRATION Evolving Treatment of Hemophilia's Impact on Neurodevelopment, Intelligence, and Other Cognitive Functions (eTHINK); NCT03660774; https://clinicaltrials.gov/ct2/show/NCT03660774.
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Affiliation(s)
| | - Karin S Walsh
- Children's National Hospital and The George Washington University School of Medicine, Washington, DC
| | - Cathy Buranahirun Burns
- Keck School of Medicine, University of Southern California/Children's Hospital Los Angeles, Los Angeles, CA
| | - Stacy E Croteau
- Boston Children's Hospital/Harvard Medical School, Boston, MA
| | - Anja Markert
- Novo Nordisk Health Care AG, Zurich, Switzerland
| | | | - Cara Hannemann
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN
| | - Madhvi Rajpurkar
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan/Wayne State University, Detroit, MI
| | | | - Greta N Wilkening
- University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO
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Rowe K, Ruiz Pozuelo J, Nickless A, Nkosi AD, Dos Santos A, Kahn K, Tollman S, Wagner RG, Scerif G, Stein A. The adolescent HIV executive function and drumming (AHEAD) study, a feasibility trial of a group drumming intervention amongst adolescents with HIV. AIDS Care 2023; 35:1796-1814. [PMID: 37039077 DOI: 10.1080/09540121.2023.2195607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/20/2023] [Indexed: 04/12/2023]
Abstract
AHEAD feasibility trial assessed the feasibility and acceptability of an 8-session group drumming programme aiming to improve executive function, depression and anxiety symptoms, and perceived social support in adolescents living with HIV in a rural low-income South African setting. Sixty-eight 12- to 19-year-old adolescents participated. They were individually randomised. The intervention arm (n = 34) received weekly hour-long group drumming sessions. Controls (n = 34) received no intervention. Feasibility and acceptability were assessed using rates of: enrolment; retention; attendance; logistical problems; adolescent-reported acceptability. Secondary measures included: five Oxford Cognitive Screen-Executive Function (OCS-EF) tasks; two Rapid Assessment of Cognitive and Emotional Regulation (RACER) tasks; the Self-Reporting Questionnaire-20 (SRQ-20) measuring depression and anxiety symptoms; the Multidimensional Scale of Perceived Social Support (MSPSS). All feasibility criteria were within green progression limits. Enrolment, retention, and acceptability were high. There was a positive effect on adolescent depressed mood with signal for a working memory effect. There were no significant effects on executive function or socio-emotional scales. Qualitative findings suggested socio-emotional benefits including: group belonging; decreased internalised stigma; improved mood; decreased anxiety. Group drumming is a feasible and acceptable intervention amongst adolescents living with HIV in rural South Africa. A full-scale trial is recommended.
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Affiliation(s)
- Kirsten Rowe
- Department of Psychiatry, University of Oxford, Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Julia Ruiz Pozuelo
- Department of Psychiatry, University of Oxford, Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Centre for the Study of African Economies, Blavatnik School of Government, University of Oxford, Oxford, UK
| | - Alecia Nickless
- Nuffield Department of Primary Care Clinical Trials Unit, University of Oxford, Oxford, UK
- Exploristics, Belfast, UK
| | - Absolum David Nkosi
- Odeion School of Music, University of the Free State, Bloemfontein, South Africa
| | | | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, KwaZulu Natal, South Africa
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Zondo S. The cognitive remediation of attention in HIV-associated neurocognitive disorders (HAND): A meta-analysis and systematic review. F1000Res 2023; 12:1133. [PMID: 38778812 PMCID: PMC11109681 DOI: 10.12688/f1000research.132166.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/25/2024] Open
Abstract
Background: Despite medical advances in Highly Active Antiretroviral Therapy (HAART), patients living with HIV continue to be at risk for developing HIV-associated neurocognitive disorders (HAND). The optimization of non-HAART interventions, including cognitive rehabilitation therapy (CRT), shows promise in reversing the impact of HAND. No data exist indicating the efficacy of CRT in remediating attention skills following neuroHIV. This paper presents a meta-analysis of randomised and non-randomised controlled trials (RCTs) to remediate attention skills following HIV CRT. Methods: The database search included literature from Google Scholar, ERIC, Cochrane Library, ISI Web of Knowledge, PubMed, PsycINFO, and grey literature published between 2013 and 2022. Inclusion criteria included studies with participants living with HIV who had undergone CRT intervention to remediate attention skills following neuroHIV. Exclusion criteria included case studies, non-human studies, and literature reviews. To assess study quality, including, randomisation, allocation concealment, participant and personnel blinding, the Cochrane Collaboration ratings system was applied. Results: A total of 14 studies met the inclusion criteria (n = 532). There were significant pre- to post-intervention between-group benefits due to CRT in the experimental group relative to control conditions for the remediation of attention skills following HIV acquisition (Hedges g = 0.251, 95% CI = 0.005 to 0.497; p < 0.05). No significant effects (p > 0.05) were demonstrated for subgroup analysis. Conclusions: To the author's knowledge, this is the first meta-analysis that exclusively analyses the remediation of attention skills in the era of HAART and neuroHIV, where all studies included participants diagnosed with HIV. The overall meta-analysis effect indicates the efficacy of CRT in remediating attention skills in HIV and HAND. It is recommended that future cognitive rehabilitation protocols to remediate attention skills should be context and population-specific and that they be supplemented by objective biomarkers indicating the efficacy of the CRT. Registration: Protocols.io (01/03/2023).
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Affiliation(s)
- Sizwe Zondo
- Department of Psychology, Rhodes University, Grahamstown, Eastern Cape, South Africa
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Braamfontein, Johannesburg, Gauteng, South Africa
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Jitmun W, Palee P, Choosri N, Surapunt T. The Success of Serious Games and Gamified Systems in HIV Prevention and Care: Scoping Review. JMIR Serious Games 2023; 11:e39915. [PMID: 37669098 PMCID: PMC10509732 DOI: 10.2196/39915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 12/21/2022] [Accepted: 07/18/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AIDS, which is caused by HIV, has long been one of the most significant global public health issues. Since the beginning of the HIV epidemic, various types of nonelectronic communication tools have been commonly used in HIV/AIDS prevention and care, but studies that apply the potential of electronic games are still limited. OBJECTIVE We aimed to identify, compare, and describe serious games and gamified systems currently used in HIV/AIDS prevention and care that were studied over a specific period of time. METHODS A scoping review was conducted into serious games and gamified systems used in HIV prevention and care in various well-known digital libraries from January 2010 to July 2021. RESULTS After identifying research papers and completing the article selection process, 49 of the 496 publications met the inclusion criteria and were examined. A total of 32 articles described 22 different serious games, while 17 articles described 13 gamified systems for HIV prevention and care. CONCLUSIONS Most of the studies described in the publications were conducted in the United States, while only a few studies were performed in sub-Saharan African countries, which have the highest global HIV/AIDS infection rates. Regarding the development platform, the vast majority of HIV/AIDS gaming systems were typically deployed on mobile devices. This study demonstrates the effectiveness of using serious games and gamified systems. Both can improve the efficacy of HIV/AIDS prevention strategies, particularly those that encourage behavior change.
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Affiliation(s)
- Waritsara Jitmun
- College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Patison Palee
- College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Noppon Choosri
- Data Analytics and Knowledge Synthesis for Healthcare (DAKSH) Research Group, College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Tisinee Surapunt
- College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
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Boma PM, Panda J, Ngoy Mande JP, Bonnechère B. Rehabilitation: a key service, yet highly underused, in the management of young patients with sickle cell disease after stroke in DR of Congo. Front Neurol 2023; 14:1104101. [PMID: 37292134 PMCID: PMC10244556 DOI: 10.3389/fneur.2023.1104101] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Affiliation(s)
- Paul Muteb Boma
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi, Democratic Republic of Congo
| | - Jules Panda
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi, Democratic Republic of Congo
- Department of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Jean Paul Ngoy Mande
- Department of Neurology and Psychiatry, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Hasselt, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, University of Hasselt, Hasselt, Belgium
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Etesami MS, Saboury N, Mohraz M, SeyedAlinaghi S, Jones DL, Vance DE, Habibi Asgarabad M. Immediate and Long-Term Effects of a Computerized Cognitive Rehabilitation Therapy on Cognitive Function in People Living with HIV in Iran: A Single-Blind Two-Arm Parallel Randomized Controlled Trial. J Assoc Nurses AIDS Care 2022; 33:505-522. [PMID: 35878047 DOI: 10.1097/jnc.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Up to 50% of people with HIV (PWH) experience neurocognitive impairments (NCIs) that can interfere with everyday functioning and reduce quality of life. To address this problem, this study examined the immediate and long-term efficacy of computerized cognitive rehabilitation therapy (CCRT) on cognitive function in PWH in Tehran, Iran. Thirty PWH with NCI engaged in 24 biweekly 90-min CCRT sessions. A control group of 30 PWH and NCI received treatment-as-usual, but no CCRT. The cognitive rehabilitation protocol focused on attention, visual memory, nonverbal learning, and planning. Pretest, posttest, and follow-up cognitive measurements showed that the designed CCRT protocol was effective in improving performance in selected cognitive domains along with the global neurocognitive performance scores of PWH. These findings suggest that this CCRT protocol be considered as part of a treatment plan to address cognitive impairment for PWH. Implications for clinical practice and research are provided.
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Affiliation(s)
- Maede Sadat Etesami
- Maede Sadat Etesami, MSc, is a Clinical Psychologist and Researcher, Iranian Research Center for HIV/AIDS (IRCHA), Imam Khomeini Hospital Complex; Health Promotion Research Center, Iran University of Medical Sciences; Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran. Nadia Saboury, MSc, is a Psychologist, Department of Psychology, Faculty of Humanities, University of Science and Culture, Tehran, Iran. Minoo Mohraz, MD, MPH, is a Professor, Iranian Research Center for HIV/AIDS (IRCHA), Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran, Iran. SeyedAhmad SeyedAlinaghi, MD, PhD, MPhil, is an Associate Professor and Senior Medical Researcher, Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. Deborah L. Jones, PhD, is a Professor, Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Mojtaba Habibi Asgarabad, PhD, is an Assistant Professor, Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences; Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran; and Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Musindo O, Krabbendam L, Mutahi J, García MP, Bangirana P, Kumar M. Neurocognitive deficits and socioeconomic risk factors among children and adolescents living with HIV in sub-Saharan Africa: a systematic review. Child Adolesc Psychiatry Ment Health 2022; 16:31. [PMID: 35477577 PMCID: PMC9047261 DOI: 10.1186/s13034-022-00465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/02/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Children and adolescents living with HIV (C/ALHIV) are at a risk for significant neurocognitive deficits. There is limited literature that addresses the role of socioeconomic factors in neurocognitive deficits among CALHIV in Sub Saharan Africa (SSA), as it is very difficult to establish this causal relationship. Our systematic review was guided by the biodevelopmental framework that assumes that foundations of health and adversity affect later development and life outcomes. This systematic review aims to assess available evidence on the relationship between neurocognitive deficits and socioeconomic factors among HIV children and adolescents in SSA region. METHOD Using a pre-determined search strategy, we searched electronic databases including PubMed, web of Science and EBSCOhost (CINAHL and MEDLINE). Peer-reviewed publications that address neurocognitive deficits, psychosocial and socioeconomic risk factors among children and adolescents living with HIV in SSA were included in review. RESULTS Out of 640 articles, 17 studies from SSA met the inclusion criteria. Four studies reported no significant differences in the neurocognitive measures comparing children and adolescents with HIV infection to those uninfected. However, 10 studies suggest that C/ALHIV scored significantly low in general intellectual functions as compared to their uninfected peers. C/ALHIV were found to have substantial deficits in specific cognitive domains such as sequential processing, simultaneous processing, and learning. In addition, deficits in visuo-spatial processing, visual memory and semantic fluency were mentioned. Socioeconomic factors such as lower socioeconomic status (income, education and occupation), child orphanhood status and under-nutrition were linked with neurocognitive deficits. CONCLUSION Our findings suggest that CALHIV presented with poorer neurocognitive outcomes when compared to other populations which were associated with specific socioeconomic factors.
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Affiliation(s)
- Otsetswe Musindo
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Lydiah Krabbendam
- grid.12380.380000 0004 1754 9227Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joan Mutahi
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Miguel Pérez García
- grid.4489.10000000121678994Facultad de Psicología, Universidad de Granada, Granada, Spain
| | - Paul Bangirana
- grid.11194.3c0000 0004 0620 0548Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Manasi Kumar
- grid.10604.330000 0001 2019 0495Department of Psychiatry , University of Nairobi to Brain and Mind Institute Aga Khan University , Nairobi, Kenya
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Familiar I, Sikorskii A, Chhaya R, Weiss J, Seffren V, Ojuka JC, Awadu J, Boivin MJ. Early Childhood Vigilance Test (ECVT) of attention in younger HIV-exposed Ugandan children predicts Tests of Variables of Attention (TOVA) at school age. Neuropsychology 2022; 36:185-194. [PMID: 35007091 PMCID: PMC9907227 DOI: 10.1037/neu0000788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: Evaluate a computerized-based attention test in early infancy in predicting neurocognitive school-age performance in human immunodeficiency virus (HIV)-exposed uninfected children. Method: Thirty-eight Ugandan HIV-exposed/uninfected children (17 boys, 21 girls) were evaluated with the Early Childhood Vigilance Test (ECVT) of attention between 3 and 5 years of age, which is a 6-min 44 s animation with colorful animals that greet the child and move across the screen. Attention was proportion of total animation time viewing a computer screen, as well as the proportion of time tracking the moving animal using eye tracking. These children were then again tested at least 2 years later (between 5 and 9 years of age) with the Kaufman Assessment Battery for Children, 2nd Edition (KABC-II) and the visual computerized Tests of Variables of Attention (TOVA). Results: Irrespective of whether scored by webcam video scoring or using automated eye tracking to compute proportion of time viewing the animation, ECVT attention was significantly correlated with all TOVA outcomes for vigilance attention. This was still the case when the correlation was adjusted for type of caregiver training for the mother, child gender, socioeconomic status (SES), and quality of Home Observational Measurement Evaluation (HOME) environment-especially for the TOVA response time variability to signal (p = .03). None of the ECVT attention performance measures correlated significantly with any of the KABC-II cognitive ability outcomes. Conclusion: Attention assessment in early childhood is predictive of school-age computer-based measures of attention and can be used to gauge the effects of factors of early risk and resilience in brain/behavior development in African children affected by HIV. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | - Ronak Chhaya
- College of Human Medicine, Michigan State University
| | | | | | | | - Jorem Awadu
- Departments of Psychiatry, Michigan State University
| | - Michael J. Boivin
- Departments of Psychiatry, Michigan State University,Department of Neurology & Ophthalmology, Michigan State University,Department of Psychiatry, University of Michigan
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10
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A Systematic Review on Serious Games in Attention Rehabilitation and Their Effects. Behav Neurol 2022; 2022:2017975. [PMID: 35256889 PMCID: PMC8898139 DOI: 10.1155/2022/2017975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/03/2022] [Indexed: 12/03/2022] Open
Abstract
Attention is a basic and main mental task and can play an important role in the functioning of other brain abilities such as intelligence, memory, learning, and perception, and its deficit occurs in 80% of patients with traumatic brain injury. The use of game-based tools for rehabilitation is rapidly expanding. Cognitive rehabilitation via video games is an emerging hot topic in cognitive science. Serious games serve a specific purpose in addition to entertainment. They can be more engaging than exercises since they replace reward and motivation systems with real-world motivations as a complement for rehabilitation activities. This study was aimed at identifying and categorizing serious computer games used for attention rehabilitation and evaluating their effects. Six electronic databases (Scopus, PubMed, ISI, Embase, IEEE, and Cochrane) were searched in August 2021. The search strategy consisted of three main concepts of “serious game”, “cognitive deficits”, and “cognitive rehabilitation”. The inclusion criteria were (1) journal articles, (2) English language, (3) being published in the last 10 years, (4) human participants, and (5) game-based intervention. In the 30 included studies, 22 unique games were utilized for attention rehabilitation. Lumosity (20%), Brain Age (Dr. Kawashima's Brain Training) (10%), and MoHRS (6.66%) were the most common games among the studies. There were (57%) casual, (23%) action, (10%) simulation, and (10%) multiple genres. Of the 47 tools used in the studies, 5 utilized cross-modal oddball attention tasks, 4 utilized game performance, 3 utilized the paced auditory serial additional test (PASAT), and the rest employed other tools. A total of 73 outcome measures were related to attention, 42 measures did not have significant results, 30 were significantly improved, 1 was significantly deteriorated, and 4 articles did not have any specific measures for attention evaluation. Thus, the results revealed the positive effect of serious games on attention. However, issues such as absence of scientific teams, the variety of the disorders that cause defects, the variety of criteria, differences in measurements, lack of long-term follow-up, insufficient RCT studies, and small sample sizes should be considered when designing, developing, and using game-based systems to prevent bias.
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Glenn Fowler M, Boivin MJ, Familiar I, Nyangoma B. Central Nervous System and Neurodevelopmental Outcomes of HIV+ and HIV exposed children: A Mini Review of Recent Findings and Lessons Learned from the Field. Neurosci Lett 2022; 775:136501. [PMID: 35122932 DOI: 10.1016/j.neulet.2022.136501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/11/2022] [Accepted: 01/28/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Mary Glenn Fowler
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Michael J Boivin
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Itziar Familiar
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Betty Nyangoma
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
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Larrivey V, Neva J, Finn K, Sikorskii A, Familiar-Lopez I, Ucheagwu V, Ezeamama A, Ruisenor-Escudero H, Nakasujja N, Boivin M, Giordani B. Daily Training efficiency during computerized cognitive rehabilitation training (CCRT): an analysis from a randomized trial in Ugandan children with and without severe malaria. Child Neuropsychol 2022; 28:197-211. [PMID: 34380364 PMCID: PMC8727492 DOI: 10.1080/09297049.2021.1962266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Children in Uganda are at risk for significant cognitive sequelae from severe malaria. Computerized cognitive rehabilitation training (CCRT) represents a potential method to improve working memory, behavior, and executive functioning, cognitive domains most at risk following severe malaria. The primary aim of this study was to complete a secondary analysis of data from a concluded CCRT randomized control trial in order to compare the training efficiency of a commonly used CCRT program under conditions of titrated (adaptive) or non-titrated (non-adaptive) training and with children with increasing malaria severity to determine how various factors may affect potential CCRT improvement. A total of 201 school-aged children (66.2% boys) who were either healthy (n = 102) or previously diagnosed with severe or cerebral malaria (n = 99) were randomized into two active treatment arms (titrated and non-titrated learning). Each child received 24 one-hour sessions of training over 8 weeks using Captain's Log® CCRT by BrainTrain, which includes a comprehensive set of CCRT tasks. Children generally benefited from CCRT over the 24 training sessions, but titrated CCRT showed a clear advantage over non-titrated. Severity of illness or factors such as BMI, did not moderate CCRT performance indicators. These findings support our hypothesis that titrated CCRT would result in steeper improvement in learning, but do not support our hypothesis that history of recent significant illness would affect learning proficiency. Findings were evident across all CCRT performance scores, even given that children were from generally rural, low-resource settings and were generally unfamiliar with computers.ABBREVIATIONS:Computerized Cognitive Rehabilitation Training (CCRT); Mental Processing Index (MPI); Home Observation for the Measurement of the Environment (HOME); Socioeconomic Status (SES); least square means (LSM).
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Affiliation(s)
| | | | | | - Alla Sikorskii
- Michigan State University, Global Neuropsychiatry Program
| | | | - Valentine Ucheagwu
- Departments of Psychiatry, Neurology, Psychology and School of Nursing, University of Michigan
| | - Amara Ezeamama
- Michigan State University, Global Neuropsychiatry Program
| | | | - Noeline Nakasujja
- Makerere School of Medicine; Madonna University, Nigeria, Okija Campus
| | - Michael Boivin
- University of Michigan,Michigan State University, Global Neuropsychiatry Program
| | - Bruno Giordani
- Departments of Psychiatry, Neurology, Psychology and School of Nursing, University of Michigan
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13
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Niemczak CE, Lichtenstein JD, Magohe A, Amato JT, Fellows AM, Gui J, Huang M, Rieke CC, Massawe ER, Boivin MJ, Moshi N, Buckey JC. The Relationship Between Central Auditory Tests and Neurocognitive Domains in Adults Living With HIV. Front Neurosci 2021; 15:696513. [PMID: 34658754 PMCID: PMC8517794 DOI: 10.3389/fnins.2021.696513] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/07/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: Tests requiring central auditory processing, such as speech perception-in-noise, are simple, time efficient, and correlate with cognitive processing. These tests may be useful for tracking brain function. Doing this effectively requires information on which tests correlate with overall cognitive function and specific cognitive domains. This study evaluated the relationship between selected central auditory focused tests and cognitive domains in a cohort of normal hearing adults living with HIV and HIV- controls. The long-term aim is determining the relationships between auditory processing and neurocognitive domains and applying this to analyzing cognitive function in HIV and other neurocognitive disorders longitudinally. Method: Subjects were recruited from an ongoing study in Dar es Salaam, Tanzania. Central auditory measures included the Gap Detection Test (Gap), Hearing in Noise Test (HINT), and Triple Digit Test (TDT). Cognitive measures included variables from the Test of Variables of Attention (TOVA), Cogstate neurocognitive battery, and Kiswahili Montreal Cognitive Assessment (MoCA). The measures represented three cognitive domains: processing speed, learning, and working memory. Bootstrap resampling was used to calculate the mean and standard deviation of the proportion of variance explained by the individual central auditory tests for each cognitive measure. The association of cognitive measures with central auditory variables taking HIV status and age into account was determined using regression models. Results: Hearing in Noise Tests and TDT were significantly associated with Cogstate learning and working memory tests. Gap was not significantly associated with any cognitive measure with age in the model. TDT explained the largest mean proportion of variance and had the strongest relationship to the MoCA and Cogstate tasks. With age in the model, HIV status did not affect the relationship between central auditory tests and cognitive measures. Age was strongly associated with multiple cognitive tests. Conclusion: Central auditory tests were associated with measures of learning and working memory. Compared to the other central auditory tests, TDT was most strongly related to cognitive function. These findings expand on the association between auditory processing and cognitive domains seen in other studies and support evaluating these tests for tracking brain health in HIV and other neurocognitive disorders.
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Affiliation(s)
- Christopher E. Niemczak
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jonathan D. Lichtenstein
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Albert Magohe
- Department of Otorhinolaryngology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jennifer T. Amato
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Abigail M. Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jiang Gui
- Department of Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Michael Huang
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Catherine C. Rieke
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Enica R. Massawe
- Department of Otorhinolaryngology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael J. Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI, United States
| | - Ndeserua Moshi
- Department of Otorhinolaryngology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jay C. Buckey
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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14
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Thomas T, Tan M, Ahmed Y, Grigorenko EL. A Systematic Review and Meta-Analysis of Interventions for Orphans and Vulnerable Children Affected by HIV/AIDS Worldwide. Ann Behav Med 2021; 54:853-866. [PMID: 32525205 DOI: 10.1093/abm/kaaa022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Worldwide, there are more than 13.3 million orphans and vulnerable children affected by Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) (HIV OVC), defined as individuals below the age of 18 who have lost one or both parents to HIV/AIDS or have been made vulnerable by HIV/AIDS; they are at risk for negative psychosocial and cognitive outcomes. PURPOSE This meta-analysis aimed to examine the scientific literature on available interventions for HIV OVC, with a focus on community-based interventions (CBI). METHODS Systematic electronic searches were conducted from four databases between October 2016 and April 2017 to identify articles investigating the effectiveness of interventions for HIV OVC. Effect sizes were calculated for each article which provided enough information and data points for analyses. RESULTS Seventy-four articles were reviewed, including psychosocial interventions (d = 0.30), cognitive interventions (d = 0.14), social protection interventions (d = 0.36), and community-based interventions (CBI; d = 0.36). Study-specific effect sizes varied widely, ranging from -1.09 to 2.26, that is, from a negative effect to an impressively large positive one, but the majority of studies registered small to medium effects (the overall effect size for all studies was 0.32, SE = 0.03, 95% CI: 0.26-0.37). Social protection interventions had the highest positive outcomes whereas CBI tended to have the fewest significant positive outcomes, with some outcomes worsening instead of improving. CONCLUSIONS Overall, interventions provided to OVC have potential for improving cognitive, psychosocial, and risk-behavior outcomes. Social protection interventions and CBI had the highest effect sizes, but CBI had positive effects on fewer outcomes and demonstrated some negative effects. CBI warrant scrutiny for improvement, as they represent an important form of culturally embedded services with potentially long-term benefits to OVC, yet appear to be differentially effective. Successful components of other types of intervention were identified, including cash grants, mentorship, and family therapy. In addition, more research is needed that attends to which interventions may be more effective for specific populations, or that studies cost-effectiveness.
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Affiliation(s)
- Tina Thomas
- Department of Psychology, University of Houston, Houston, TX
| | - Mei Tan
- Department of Psychology, University of Houston, Houston, TX
| | - Yusra Ahmed
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX
| | - Elena L Grigorenko
- Department of Psychology, University of Houston, Houston, TX.,Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX.,Molecular and Human Genetics, Baylor College of Medicine, Houston, TX.,Moscow State University for Psychology and Education, Moscow, Russian Federation
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15
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van Zyl C, Badenhorst M, Hanekom S, Heine M. Unravelling 'low-resource settings': a systematic scoping review with qualitative content analysis. BMJ Glob Health 2021; 6:e005190. [PMID: 34083239 PMCID: PMC8183220 DOI: 10.1136/bmjgh-2021-005190] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as 'low-to-middle-income countries' or 'developing countries', are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings. METHODS A systematic scoping review was undertaken to start unravelling the term 'low-resource setting'. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to 'low-resource setting' and 'rehabilitation'. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used. RESULTS A total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term 'low-resource setting'. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices. CONCLUSION The emerging themes may assist with (1) the groundwork needed to unravel 'low-resource settings' in health-related research, (2) moving away from assumptive umbrella terms like 'low-to-middle-income countries' or 'low/middle-income countries' and (3) promoting effective knowledge transfer between settings.
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Affiliation(s)
- Chanel van Zyl
- Division of Physiotherapy, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Marelise Badenhorst
- Institute of Sport and Exercise Medicine, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Martin Heine
- Institute of Sport and Exercise Medicine, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
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16
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Rowe K, Duta M, Demeyere N, Wagner RG, Pettifor A, Kahn K, Tollman S, Scerif G, Stein A. The relationship between executive function, risky behaviour and HIV in young women from the HPTN 068 study in rural South Africa. AIDS Care 2021; 33:682-692. [PMID: 33258691 PMCID: PMC8650142 DOI: 10.1080/09540121.2020.1851016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
Executive function (EF) may predict sexual risk-taking and HIV risk in young women in rural South Africa. We tested associations between EF and seven risky behavioural outcomes: binge drinking, illicit substance use, unprotected vaginal sex, concurrent sexual relationships, transactional sex, herpes simplex virus type 2 (HSV-2) infection, and HIV infection. We compared EF in young women with HIV to matched controls. 1080 young women underwent cognitive assessments. Better verbal short-term memory was associated with a lower risk of HSV-2 (OR 0.77; 95% CI 0.69, 0.86; p < 0.001). Uncorrected trends (p < 0.05) were better verbal working memory being associated with a lower risk of concurrency, better planning with a lower risk of illicit drug use, and better affective inhibition with a lower risk of transactional sex. 78 participants with sexually acquired HIV were matched with 153 HIV-negative controls and had poorer verbal working memory than controls (Hedge's g = -0.38; 95% CI -0.66, -0.10; p = 0.0076), but this was non-significant after adjustment. EF's contribution to young women's risky behaviour in this context does not hold when stringent statistical corrections are applied, with only verbal short term memory reaching statistical significance as predictor. Replication in other samples is recommended.
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Affiliation(s)
- Kirsten Rowe
- Department of Psychiatry, University of Oxford, Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Mihaela Duta
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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17
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Boivin MJ, Chernoff M, Fairlie L, Laughton B, Zimmer B, Joyce C, Barlow-Mosha L, Bwakura-Dangarembizi M, Vhembo T, Ratswana M, Kamthunzi P, McCarthy K, Familiar-Lopez I, Jean-Philippe P, Coetzee J, Abrahams N, Gous H, Violari A, Cotton MF, Palumbo PE. African Multi-Site 2-Year Neuropsychological Study of School-Age Children Perinatally Infected, Exposed, and Unexposed to Human Immunodeficiency Virus. Clin Infect Dis 2021; 71:e105-e114. [PMID: 31848582 DOI: 10.1093/cid/ciz1088] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Children living with human immunodeficiency virus (HIV) are at neuropsychological risk for cognitive and motor dysfunction. However, few prospective, multi-site studies have evaluated neuropsychological outcomes longitudinally among perinatally infected African children who received early antiretroviral treatment (ART). METHODS We enrolled 611 children aged 5 to 11 years at 6 sites (South Africa [3], Zimbabwe, Malawi, Uganda). Of these, there were 246 children living with HIV (HIV+) who were initiated on ART before 3 years of age in a prior clinical trial comparing nevirapine to lopinavir/ritonavir (International Maternal Pediatric Adolescent Acquired Immunodeficiency Syndrome Clinical Trials [IMPAACT] P1060); 183 age-matched, exposed but uninfected (HEU) children; and 182 unexposed and uninfected (HUU) children. They were compared across 3 assessment time points (Weeks 0, 48, and 96) on cognitive ability (Kaufman Assessment Battery for Children, second edition [KABC-II]), attention/impulsivity (Tests of Variables of Attention [TOVA]), motor proficiency (Bruininks-Oseretsky Test, second edition [BOT-2]), and on the Behavior Rating Inventory of Executive Function (BRIEF). The cohorts were compared using linear mixed models, adjusting for site, child's age and sex, and selected personal/family control variables. RESULTS The HIV+ cohort performed significantly worse than the HEU and HUU cohorts for all KABC-II, TOVA, and BOT-2 performance outcomes across all 3 time points (P values < .001). The HUU and HEU cohorts were comparable. For the KABC-II planning/reasoning subtests, the HIV+ children showed less improvement over time than the HUU and HEU groups. The groups did not differ significantly on the BRIEF. CONCLUSIONS Despite initiation of ART in early childhood and good viral suppression at the time of enrollment, the HIV+ group had poorer neuropsychological performance over time, with the gap progressively worsening in planning/reasoning. This can be debilitating for self-management in adolescence.
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Affiliation(s)
- Michael J Boivin
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA.,Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, USA.,Department of Psychiatry, the University of Michigan, Ann Arbor, Michigan, USA
| | - Miriam Chernoff
- Center for Biostatistics in Acquired Immunodeficiency Syndrome Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lee Fairlie
- Wits Reproductive Health and Human Immunodeficiency Virus Research Centre, Shandukani Clinic, Johannesburg, South Africa
| | - Barbara Laughton
- Family Centre for Research with UBUNTU, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | | | - Celeste Joyce
- Perinatal Human Immunodeficiency Virus Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
| | | | - Tichaona Vhembo
- Harare Family Care CRS, University of Zimbabwe, College of Health Sciences Clinical Trials Unit, Harare, Zimbabwe
| | - Mmule Ratswana
- Wits Reproductive Health and Human Immunodeficiency Virus Research Centre, Shandukani Clinic, Johannesburg, South Africa
| | - Portia Kamthunzi
- University of North Carolina Project-Lilongwe, Malawi CRS, Lilongwe, Malawi
| | - Katie McCarthy
- Clinical Research Management, FHI360, Durham, North Carolina, USA
| | | | - Patrick Jean-Philippe
- National Institute of Allergy and Infectious Diseases, National Institute of Health, Rockville, Maryland, USA
| | - Joan Coetzee
- Family Centre for Research with UBUNTU, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Nasreen Abrahams
- Perinatal Human Immunodeficiency Virus Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Hermien Gous
- Wits Reproductive Health and Human Immunodeficiency Virus Research Centre, Shandukani Clinic, Johannesburg, South Africa
| | - Avy Violari
- Perinatal Human Immunodeficiency Virus Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark F Cotton
- Family Centre for Research with UBUNTU, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Paul E Palumbo
- Hitchcock Medical School of Dartmouth University, New Lebanon, New Hampshire, USA
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18
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Rowe K, Buivydaite R, Heinsohn T, Rahimzadeh M, Wagner RG, Scerif G, Stein A. Executive function in HIV-affected children and adolescents: a systematic review and meta-analyses. AIDS Care 2021; 33:833-857. [PMID: 33764813 DOI: 10.1080/09540121.2021.1873232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This review aimed to determine: whether EF is affected in children and adolescents (2-24-years-old) with perinatal HIV infection, perinatal HIV exposure without infection, and behaviourally acquired HIV. A systematic review (PROSPERO number: CRD42017067813) was conducted using 11 electronic databases (01.01.1981-09.07.2019) and 8 conference websites. Primary quantitative studies with EF scores on cognitive tasks and/or behavioural report measures were included. Meta-analyses were performed by EF subtype and subpopulations compared. 1789 records were found. Sixty-one studies were included in the narrative synthesis; 32 (N = 7884 participants) were included in meta-analyses. There was a distinct pattern of reduced EF in those with perinatal HIV infection on antiretroviral therapy compared to controls: pooled effect sizes were largest for verbal and visuospatial working memory, with smaller effects on planning, inhibitory control and set-shifting. Data were limited for other HIV-affected subpopulations. Perinatal HIV infection is associated with reduced EF with varying effect sizes for the different EF subtypes.
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Affiliation(s)
- Kirsten Rowe
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Ruta Buivydaite
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Torben Heinsohn
- Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Mana Rahimzadeh
- Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa.,Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Gaia Scerif
- Developmental Cognitive Neuroscience, Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alan Stein
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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19
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Van Pelt AE, Lipow MI, Scott JC, Lowenthal ED. Interventions for Children with Neurocognitive Impairments in Resource-Limited Settings: A Systematic Review. CHILDREN AND YOUTH SERVICES REVIEW 2020; 118:105393. [PMID: 32968334 PMCID: PMC7505233 DOI: 10.1016/j.childyouth.2020.105393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many children and adolescents around the world suffer from neurocognitive deficits due to chronic disorders, such as Human Immunodeficiency Virus (HIV) and malaria. Resource-limited settings exacerbate the risk of negative cognitive outcomes due to high prevalence of associated disorders, poverty, and limited access to interventions. Current literature does not provide consensus regarding the efficacy of interventions to support children with cognitive impairments in low-resource settings. This research aimed to identify and evaluate interventions for youth with neurocognitive deficits in resource-limited settings. A systematic review of peer-reviewed literature was conducted within five databases (PubMed, Web of Science, CINAHL, PsycInfo, and WHO Index Medicus). Cognitive impairment was broadly defined to be inclusive of aspects of intellectual and cognitive functioning (e.g., working memory, attention, executive function). The income status of the country or countries in which each study was located was determined according to World Bank Income Status. Studies conducted in countries classified as low- or middle-income were included. Since low-resource areas exist within high-income countries, the resource availability within study settings in high-income countries was systematically evaluated for inclusion. The search yielded 19 articles that met all inclusion criteria. Interventions included strategies involving caregiver training, computerized and non-computerized cognitive training, physical activity, and nutritional supplementation. Interventions were administered in medical facilities, educational facilities, or the home. The majority of the interventions targeted the domains of memory and attention. Overall, the efficacy of interventions was inconsistent. Further, results indicated that the relationship between cognitive improvement and intervention types was not consistent across cognitive domains. However, when evaluating studies on an individual basis, some strategies demonstrated clinically- and statistically-significant improvement in cognitive function among specific groups of children. The low article yield highlights that few researchers have evaluated pediatric cognitive support interventions in low-resource contexts. This review suggests support strategies that should be considered for future studies as neurocognitive screening capacity improves in resource-limited settings.
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Affiliation(s)
- Amelia E. Van Pelt
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, Pennsylvania, United States 19104-6021
- Department of Pediatrics (Global Health Center), Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3501 Civic Center Blvd, Philadelphia, Pennsylvania, United States 19104
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center, 3461 Locust Walk, Philadelphia, Pennsylvania, United States 19104-6218
| | - Matthew I. Lipow
- Department of Pediatrics (Global Health Center), Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3501 Civic Center Blvd, Philadelphia, Pennsylvania, United States 19104
- Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, Pennsylvania, United States 19129
| | - J. Cobb Scott
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Richards Building, 5th Floor, 3700 Hamilton Walk, Philadelphia, Pennsylvania, 19104-6085 United States
- VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, 3900 Woodland Ave, MC116, Philadelphia, PA, 19104, United States
| | - Elizabeth D. Lowenthal
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, Pennsylvania, United States 19104-6021
- Department of Pediatrics (Global Health Center), Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3501 Civic Center Blvd, Philadelphia, Pennsylvania, United States 19104
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20
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Chan T, Marta M, Hawkins C, Rackstraw S. Cognitive and Neurologic Rehabilitation Strategies for Central Nervous System HIV Infection. Curr HIV/AIDS Rep 2020; 17:514-521. [PMID: 32844275 PMCID: PMC7497368 DOI: 10.1007/s11904-020-00515-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Cognitive impairment leading to disability is increasingly seen in people living with human immunodeficiency virus (PLWH). Rehabilitation can alleviate the effects of cognitive impairment upon function. The aim of this paper is to discuss the strategies that have been used in cognitive and neurologic rehabilitation in PLWH. RECENT FINDINGS Studies examining pharmacological and non-pharmacological strategies were analysed. Medical management of HIV and co-morbidities should be optimised. Non-pharmacological strategies, including nerve stimulation techniques, exercise-based interventions, and paper and computer-based cognitive rehabilitation, have some evidence supporting their use in PLWH either as stand-alone interventions or as part of a multidisciplinary approach. Both pharmacological and non-pharmacological rehabilitation strategies have been used with PLWH. More intervention trials are needed to assess cognitive and neurological rehabilitation strategies and further evaluate their potential benefit in PLWH.
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Affiliation(s)
- Terrence Chan
- Mildmay Hospital, 19 Tabernacle Gardens, London, E2 7DZ, UK
| | - Monica Marta
- Grahame Hayton Unit, I&I and Neurology Department, Barts Health NHS Trust, London, UK
- Neurosciences, Blizard Institute, Queen Mary University of London, London, UK
| | | | - Simon Rackstraw
- Mildmay Hospital, 19 Tabernacle Gardens, London, E2 7DZ, UK.
- Grahame Hayton Unit, I&I and Neurology Department, Barts Health NHS Trust, London, UK.
- Neurosciences, Blizard Institute, Queen Mary University of London, London, UK.
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Abstract
Human immunodeficiency virus (HIV) is a neurotropic virus that has a detrimental impact on the developing central nervous system (CNS) of children growing up with perinatal HIV (PHIV) due to a combination of pathophysiological processes related to direct viral cytopathic effects and immune activation. This leads to a spectrum of neurocognitive impairment ranging from severe encephalopathy to subtle domain-specific cognitive impairments, as well as psychological disorders that are compounded by HIV-related stigma and sociodemographic factors that disproportionately affect PHIV children. Early commencement and consistent use of combination antiretroviral therapy (cART) has resulted in a dramatic improvement in neuropsychological outcomes for PHIV children; however, they remain vulnerable to cognitive impairment and psychological disorders, as evidenced by imaging findings, randomised clinical trials and observational studies. An optimal neuroprotective cART regimen remains elusive in children, but systemic viral suppression, regular neurocognitive and psychological screening and ready access to neuropsychological management strategies are key components for optimising neuropsychological outcomes. However, a lack of standardised and validated screening tools, particularly in resource-limited settings, hinders a precise understanding of the nature, prevalence and associations between neuropsychological symptomatology and HIV health. This article reviews the natural history, cellular pathophysiology and structural and functional imaging findings for children growing up with HIV, as well as summarising management strategies related to antiretroviral therapy, screening tools and specific interventions for neurocognitive impairments and psychological disorders.
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Thomas T, Ahmed Y, Tan M, Grigorenko EL. Cognitive and Educational Interventions for Orphans and Vulnerable Children Affected by HIV/AIDS: A Meta-Analysis. Child Dev 2020; 92:7-20. [PMID: 32767770 DOI: 10.1111/cdev.13438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Orphans and vulnerable children affected by HIV/AIDS (HIV OVC) are at risk for cognitive difficulties and lack of access to education. Interventions addressing cognitive or educational outcomes for HIV OVC worldwide were examined through systematic searches conducted from October 2016 to 2019. We examined the summative effectiveness of interventions and the specific effects of participant age and intervention length. Interventions targeting cognitive outcomes had a small, significant effect, with no effect of moderating variables. Interventions targeting educational outcomes had significant effects. Educational interventions over 1 year were effective, but effects of intervention length were not significant. Overall, this review provides support for the effectiveness of interventions targeting cognitive and educational outcomes for OVC and highlights the need for more research on such interventions.
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Abstract
This study aimed to assess the association between suicidal ideation among mothers living with HIV in Zimbabwe and the cognitive development of their children. Participants were mother–child dyads recruited from two rural districts in Zimbabwe. Data were collected at baseline and 12 months follow-up. Suicidal ideation was assessed using item-10 from the Edinburgh postnatal depression scale. Mixed-effects linear regression was used to assess the association of child cognitive outcomes at follow-up (using the Mullen scales of early learning) with maternal suicidal ideation. Mothers with suicidal ideation at baseline (n = 171) tended to be younger, unmarried, experienced moderate to severe hunger, had elevated parental stress and depression symptoms compared with non-suicidal mothers (n = 391). At follow-up, emerging maternal suicidal ideation was associated with poorer child cognitive outcomes (adjusted mean difference − 6.1; 95% CI − 10.3 to − 1.8; p = 0.03). Suicidal ideation affects child cognitive development and should be addressed, particularly in HIV positive mothers.
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Computerized Cognitive Rehabilitation Training for Ugandan Seniors Living with HIV: A Validation Study. J Clin Med 2020; 9:jcm9072137. [PMID: 32645896 PMCID: PMC7408686 DOI: 10.3390/jcm9072137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022] Open
Abstract
The feasibility, acceptability and preliminary efficacy of computerized cognitive rehabilitation therapy (CCRT) for mitigating neurocognitive decline was evaluated in African adults ≥50 years old. Eighty-one Ugandans with (n = 40) and without (n = 41) chronic human immunodeficiency viruses (HIV) were allocated CCRT—i.e., 20–45-min cognitive training sessions with culturally adapted video games delivered via Captain’s Log Software, or standard of care (SOC). Pre and post (i.e., 8-weeks later) intervention performance based neurocognitive tests, quality of life (QOL) and frailty related phenotype (FRP) were determined in all respondents. Multivariable linear regression estimated CCRT- vs. SOC-related differences (β) in neurocognitive batteries, QOL and FRP. Effect sizes (ES) for estimated β were calculated. CCRT protocol was completed by 92.8% of persons allocated to it. Regardless of HIV status, CCRT was associated with higher performance in learning tests than SOC—interference list (β = 1.00, 95%CI: (0.02, 1.98); ES = 0.43) and delayed recall (β = 1.04, 95%CI: (0.06, 2.02); ES = 0.47). CCRT effect on verbal fluency was clinically important (ES = 0.38), but statistical significance was not reached (β = 1.25, 95%CI: (−0.09, 2.58)). Among HIV-positive adults, clinically important post-CCRT improvements were noted for immediate recall (ES = 0.69), working memory (ES = 0.51), verbal fluency (ES = 0.51), and timed gait (ES = −0.44) tasks. Among HIV-negative adults, CCRT resulted in moderate post-intervention improvement in learning tests (ES = 0.45) and large decline in FRP (ES = −0.71), without a positive effect on simple attention and visuomotor coordination tasks. CCRT intervention is feasible among older Ugandan adults with potential benefit for learning and verbal fluency tests regardless of HIV status and lowering FRP in HIV-negative older adults.
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Paul RH, Cho KS, Belden AC, Mellins CA, Malee KM, Robbins RN, Salminen LE, Kerr SJ, Adhikari B, Garcia-Egan PM, Sophonphan J, Aurpibul L, Thongpibul K, Kosalaraksa P, Kanjanavanit S, Ngampiyaskul C, Wongsawat J, Vonthanak S, Suwanlerk T, Valcour VG, Preston-Campbell RN, Bolzenious JD, Robb ML, Ananworanich J, Puthanakit T. Machine-learning classification of neurocognitive performance in children with perinatal HIV initiating de novo antiretroviral therapy. AIDS 2020; 34:737-748. [PMID: 31895148 PMCID: PMC7072001 DOI: 10.1097/qad.0000000000002471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To develop a predictive model of neurocognitive trajectories in children with perinatal HIV (pHIV). DESIGN Machine learning analysis of baseline and longitudinal predictors derived from clinical measures utilized in pediatric HIV. METHODS Two hundred and eighty-five children (ages 2-14 years at baseline; Mage = 6.4 years) with pHIV in Southeast Asia underwent neurocognitive assessment at study enrollment and twice annually thereafter for an average of 5.4 years. Neurocognitive slopes were modeled to establish two subgroups [above (n = 145) and below average (n = 140) trajectories). Gradient-boosted multivariate regressions (GBM) with five-fold cross validation were conducted to examine baseline (pre-ART) and longitudinal predictive features derived from demographic, HIV disease, immune, mental health, and physical health indices (i.e. complete blood count [CBC]). RESULTS The baseline GBM established a classifier of neurocognitive group designation with an average AUC of 79% built from HIV disease severity and immune markers. GBM analysis of longitudinal predictors with and without interactions improved the average AUC to 87 and 90%, respectively. Mental health problems and hematocrit levels also emerged as salient features in the longitudinal models, with novel interactions between mental health problems and both CD4 cell count and hematocrit levels. Average AUCs derived from each GBM model were higher than results obtained using logistic regression. CONCLUSION Our findings support the feasibility of machine learning to identify children with pHIV at risk for suboptimal neurocognitive development. Results also suggest that interactions between HIV disease and mental health problems are early antecedents to neurocognitive difficulties in later childhood among youth with pHIV.
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Affiliation(s)
- Robert H Paul
- Missouri Institute of Mental Health, University of Missouri-St. Louis, Missouri
| | - Kyu S Cho
- Missouri Institute of Mental Health, University of Missouri-St. Louis, Missouri
| | - Andrew C Belden
- Missouri Institute of Mental Health, University of Missouri-St. Louis, Missouri
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, and Columbia University, New York
| | - Kathleen M Malee
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, and Columbia University, New York
| | - Lauren E Salminen
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, University of Southern California, Marina del Rey, California, USA
| | - Stephen J Kerr
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center
- Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Badri Adhikari
- Department of Mathematics and Computer Science, University of Missouri-St. Louis, Missouri, USA
| | - Paola M Garcia-Egan
- Missouri Institute of Mental Health, University of Missouri-St. Louis, Missouri
| | - Jiratchaya Sophonphan
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, and Columbia University, New York
| | | | - Kulvadee Thongpibul
- Department of Psychology, Faculty of Humanities, Chiang Mai University, Chiang Mai
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen
| | | | | | - Jurai Wongsawat
- Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand
| | | | - Tulathip Suwanlerk
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Victor G Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | | | - Jacob D Bolzenious
- Missouri Institute of Mental Health, University of Missouri-St. Louis, Missouri
| | - Merlin L Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Jintanat Ananworanich
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Thanyawee Puthanakit
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Mebrahtu H, Sherr L, Simms V, Weiss HA, Chingono R, Rehman AM, Ndlovu P, Cowan FM. The impact of common mental disorders among caregivers living with HIV on child cognitive development in Zimbabwe. AIDS Care 2020; 32:198-205. [PMID: 32172592 DOI: 10.1080/09540121.2020.1739216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This paper aimed to assess the impact of maternal common mental disorders (CMD) among caregivers living with HIV on the cognitive functioning of their child. Data were collected at baseline and 12 months follow-up from mother-child dyads recruited as part of an ongoing trial in Zimbabwe. Symptoms of CMD were assessed using the Shona Symptom Questionnaire. Mixed-effects linear regression was used to assess child cognitive scores at follow-up (using the Mullen Scales of Early Learning) in relation to caregiver CMD prevalence over 12 months. At baseline, caregivers reporting CMD (n = 230; 40.1%) were less likely to have completed higher education (46.9% vs. 56.9%; p = 0.02), more likely to be unmarried (27.8% vs. 16.0%; p < 0.01), and experience food insecurity (50.0% vs. 29.4%; p < 0.01) compared to the group without CMD (n = 344). There were 4 CMD patterns over time: (i) Emerging CMD (n = 101; 19.7% of caregivers) defined as those who were below the cut-off at baseline, and above it at 12 months; (ii) Improving CMD (n = 76; 14.8%) defined as those who reported CMD at baseline, and were below the cut-off by follow-up; (iii) No CMD (n = 206; 40.1%) defined as those who did not report CMD symptoms at either time point; and (iv) Chronic CMD (n = 131; 25.5%) defined as those who reported CMD above the cut-off at both time points. Children of caregivers with chronic CMD (n = 131, 25.5%) had lower receptive language scores (aMD:-2.81, 95%CI -5.1 to -0.6; p = 0.05) compared to the reference group with no CMD (n = 206, 40.1%). Exposure to caregiver CMD over a prolonged period may affect child receptive vocabulary skills.
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Affiliation(s)
- Helen Mebrahtu
- Institute of Global Health, University College London, London, UK
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
| | - Victoria Simms
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Rudo Chingono
- Centre for Sexual Health HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
| | - Andrea M Rehman
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Frances M Cowan
- World Education Inc./Bantwana (WEI/B), Bulawayo, Zimbabwe.,Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Fraser S, Cockcroft K. Working with memory: Computerized, adaptive working memory training for adolescents living with HIV. Child Neuropsychol 2019; 26:612-634. [PMID: 31594469 DOI: 10.1080/09297049.2019.1676407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study investigated working memory (WM) training for adolescents with perinatal HIV infection, since WM is negatively impacted by the virus, and adolescence is a time of considerable brain reorganization, during which WM functioning reaches maturation. We posed three main questions: 1) whether WM could be trained in adolescents living with HIV, and if so, whether these effects were maintained over a six-month period during which no further training was received; 2) whether there were differential effects of training on the components of WM (verbal and visuospatial storage, verbal and visuospatial processing); 3) whether the WM training transferred to cognate tasks, and if so, whether these transfer effects were maintained over six months. Sixty-three HIV+ adolescents (10-16 years) from two children's homes were assigned to the training (n = 31) or control (n = 32) group. The training group received 32 hours of supervised training in an adaptive, computerized WM intervention, while the control group received a supervised, placebo computerized program for the same hours. Comprehensive WM and neuropsychological batteries were administered to both groups at pretest, immediately following the intervention, and six months later. Significant improvements were found in verbal WM for the training group, which were maintained six months later. Transfer effects were evident in attention, executive function, memory, language and fluid intelligence. There were no significant posttest improvements in visuospatial storage, and minimal changes in verbal storage and visuospatial WM. These findings represent an important step in exploring ways to improve cognitive functioning in an at-risk population.
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Affiliation(s)
- Shona Fraser
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand , 2050, Johannesburg, South Africa
| | - Kate Cockcroft
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand , 2050, Johannesburg, South Africa
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28
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Mebrahtu H, Simms V, Mupambireyi Z, Rehman AM, Chingono R, Matsikire E, Malaba R, Weiss HA, Ndlovu P, Cowan FM, Sherr L. Effects of parenting classes and economic strengthening for caregivers on the cognition of HIV-exposed infants: a pragmatic cluster randomised controlled trial in rural Zimbabwe. BMJ Glob Health 2019; 4:e001651. [PMID: 31565411 PMCID: PMC6747895 DOI: 10.1136/bmjgh-2019-001651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction HIV-exposed children show signs of developmental delay. We assessed the impact of a pragmatic multicomponent intervention for caregivers of HIV-exposed children aged 0–2 years in Zimbabwe. Methods We conducted a cluster-randomised trial from 2016 to 2018. Clusters were catchments surrounding clinics, allocated (1:1) to either National HIV guidelines standard of care or standard care plus an 18-session group intervention comprising i) early childhood stimulation (ECS) and parenting training with home visits to reinforce skills and retention in HIV care; ii) economic strengthening. Primary outcomes measured 12 months after baseline (4.5 months postintervention completion) included: i) global child development measured using the Mullen early learning composite score; ii) retention in HIV care. Analysis used mixed effects regression to account for clustering and adjusted minimally for baseline prognostic factors and was by intention to treat. Results Thirty clusters, 15 in each arm, were randomised. 574 dyads were recruited with 89.5% retained at follow-up. Ninety one of 281 (32.4%) were recorded as having received the complete intervention package, with 161/281 (57.3%) attending ≥14 ECS sessions. There was no evidence of an intervention effect on global child development (intervention mean 88.1 vs standard of care mean 87.6; adjusted mean difference=0.06; 95% CI −2.68 to 2.80; p=0.97) or infant retention in care (proportion of children who had missed their most recent HIV test: intervention 21.8% vs standard of care 16.9%, p=0.18). There was weak evidence that the proportion of caregivers with parental stress was reduced in the intervention arm (adjusted OR (aOR)=0.69; 95% CI 0.45 to 1.05; p=0.08) and stronger evidence that parental distress specifically was reduced (intervention arm 17.4% vs standard of care 29.1% scoring above the cut-off; aOR=0.56; 95% CI 0.35 to 0.89; p=0.01). Conclusion This multicomponent intervention had no impact on child development outcomes within 4.5 months of completion, but had an impact on parental distress. Maternal mental health remains a high priority. Trial registration number PACTR201701001387209.
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Affiliation(s)
- Helen Mebrahtu
- Institute of Global Health, University College London, London, UK
| | - Victoria Simms
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Zivai Mupambireyi
- Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Andrea M Rehman
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rudo Chingono
- Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Edward Matsikire
- Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Rickie Malaba
- MRC Tropical Epidemiology Group, World Education Inc./Bantwana, Harare, Zimbabwe
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Patience Ndlovu
- MRC Tropical Epidemiology Group, World Education Inc./Bantwana, Harare, Zimbabwe
| | - Frances M Cowan
- Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.,International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
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Familiar I, Chernoff M, Ruisenor-Escudero H, Laughton B, Joyce C, Fairlie L, Vhembo T, Kamthunzi P, Barlow-Barlow L, Zimmer B, McCarthy K, Boivin MJ. Association between caregiver depression symptoms and child executive functioning. Results from an observational study carried out in four sub-Saharan countries. AIDS Care 2019; 32:486-494. [PMID: 31462095 DOI: 10.1080/09540121.2019.1659917] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Depressive symptoms among HIV-positive (HIV+) women may negatively impact their health and possibly that of their young children through risk of compromised caregiving. We evaluated how depression symptoms in predominantly (97%) female caregivers relate to neurodevelopmental outcomes in their HIV affected children. Data come from the IMPAACT P1104s Study, an observational cohort across six sites in four countries: Zimbabwe, South Africa, Uganda and Malawi. Participants (n = 611) were 5-11-year-old children with HIV (HIV), HIV exposed uninfected (HEU), or HIV unexposed uninfected (HUU). Primary caregivers were assessed for depression with the Hopkins Symptom Checklist (HSCL) and children with Behavior Rating Inventory for Executive Function (BRIEF) parent-report, Kauffman Assessment Battery for Children II (KABC), Bruininks-Oseretsky Test of Motor Proficiency 2nd Ed. (BOT-2), Test of Variables of Attention (TOVA), Multiple Indicators Cluster Survey, Child Disability and Development scales (MICS-4). Caregivers with higher depression scores (>1.75 mean HSCL score) reported more executive function problems in their children, regardless of HIV status. All executive function scores were significantly (p < 0.001) associated with depressive symptomatology at baseline and across time. Caregiver depressive symptomatology was not associated with other assessed neurocognitive outcomes. These results highlight the potential impact of caregiver depression on child behavioral outcomes.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
| | - Miriam Chernoff
- Center for Biostatistics in AIDS Research, Harvard University, Boston, MA, USA
| | | | - Barbara Laughton
- Department of Pediatrics and Child Health, Stellenboch University, Tygerberg, RSA
| | - Celeste Joyce
- Perinatal HIV Research Unit (PHRU), Chris Hani Baragwanath Hospital, Johannesburg, RSA
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, Shandukani Clinic, Johannesburg, RSA
| | - Tichaona Vhembo
- Harare Family Care CRS, University of Zimbabwe, Harare, Zimbabwe
| | - Portia Kamthunzi
- University of North Carolina-Lilongwe Clinical Research Institute, Lilongwe, Malawi
| | - Linda Barlow-Barlow
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | - Michael J Boivin
- Departments of Psychiatry and Neurology, Michigan State University, East Lansing, MI, USA
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Gao Y. Cognitive guidance and improvement of Alzheimer's disease patients based on human-computer interaction design. COGN SYST RES 2019. [DOI: 10.1016/j.cogsys.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Ruiseñor-Escudero H, Familiar I, Nyakato M, Kutessa A, Namukooli J, Ssesanga T, Joyce C, Laughton B, Grab J, Chernoff M, Vhembo T, Fairlie L, Kamthunzi P, Boivin M. Building capacity in neurodevelopment assessment of children in sub-Saharan Africa: A quality assurance model to implement standardized neurodevelopment testing. Child Neuropsychol 2019; 25:466-481. [PMID: 30105934 PMCID: PMC6375801 DOI: 10.1080/09297049.2018.1497588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
Compromised neurodevelopment (ND) among infants and children is prevalent in sub-Saharan Africa. Standardized testing of ND is frequently prohibitive in these contexts, as tests require skilled staff for their application. In this paper, we present a quality assurance (QA) model (QualiND) for standardized ND testing, discussing findings and implications from our experience applying the Kaufman Assessment Battery for Children second edition (KABC-II). The QualiND model was implemented within IMPAACT P1104s study, a multisite, prospective study including 615 children affected by HIV. From 2014 to 2016, the QualiND managed 18 testers across 6 sites located in 4 African countries applying the KABC-II in 9 local languages. The QualiND is a multilevel, video-assisted iterative model incorporating remote evaluation, feedback, and supervision roles. Using an ad hoc rubric, videos of test application were evaluated by experienced staff in a centralized QA center. At each study site, testers and supervisors reviewed feedback from videos received via email from the QA center and devised an action plan to address testing errors and deficiencies. There were few instances of invalid tests and few barriers to test completion. Over 97% of KABC-II tests across sites were considered to be valid by the QA center. Overall, the QualiND model was a useful platform for remote supervision to nonspecialist and minimally trained research staff. The QualiND model may be useful to researchers and organizations involved in measuring early child development using standardized tests in low and middle-income countries.
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Affiliation(s)
| | - Itziar Familiar
- a Psychiatry Department , Michigan State University , East Lansing , USA
| | - Mary Nyakato
- b Makerere University-Johns Hopkins University Research Collaboration (MU-JHU) , Kampala , Uganda
| | - Agatha Kutessa
- b Makerere University-Johns Hopkins University Research Collaboration (MU-JHU) , Kampala , Uganda
| | | | | | - Celeste Joyce
- d Chris Hani HIV Unit , University of Witwatersrand , Soweto , South Africa
| | - Barbara Laughton
- e Department of Pediatrics and Child Health , Tygerberg University , Tygerberg , South Africa
| | - Janet Grab
- f Wits Reproductive Health & HIV Institute , Shandukani Clinic , Johannesburg , South Africa
| | - Miriam Chernoff
- g Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health , Harvard University , Boston , USA
| | - Tichaona Vhembo
- h Harare Family Care , University of Zimbabwe , Harare , Zimbabwe
| | - Lee Fairlie
- f Wits Reproductive Health & HIV Institute , Shandukani Clinic , Johannesburg , South Africa
| | - Portia Kamthunzi
- i Lilongwe Clinical Research Institute , Kamuzu Central Hospital , Lilongwe , Malawi
| | - Michael Boivin
- a Psychiatry Department , Michigan State University , East Lansing , USA
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32
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Boivin MJ, Nakasujja N, Sikorskii A, Ruiseñor-Escudero H, Familiar-Lopez I, Walhof K, van der Lugt EM, Opoka RO, Giordani B. Neuropsychological benefits of computerized cognitive rehabilitation training in Ugandan children surviving severe malaria: A randomized controlled trial. Brain Res Bull 2019; 145:117-128. [PMID: 29522863 PMCID: PMC6127009 DOI: 10.1016/j.brainresbull.2018.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/17/2018] [Accepted: 03/01/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Computerized cognitive rehabilitation training (CCRT) may be beneficial for alleviating persisting neurocognitive deficits in Ugandan severe malaria survivors. We completed a randomized controlled trial of CCRT for both severe malaria and non-malaria cohorts of children. METHODS 150 school-age severe malaria and 150 non-malaria children were randomized to three treatment arms: 24 sessions of Captain's Log CCRT for attention, working memory and nonverbal reasoning, in which training on each of 9 tasks difficulty increased with proficiency; a limited CCRT arm that did not titrate to proficiency but randomly cycled across the simplest to moderate level of training; and a passive control arm. Before and after 2 months of CCRT intervention and one year following, children were tested with the Kaufman Assessment Battery for Children, 2nd edition (KABC-II), computerized CogState cognitive tests, the Behavior Rating Inventory for Executive Function (BRIEF), and the Achenbach Child Behavior Checklist (CBCL). RESULTS Malaria children assigned to the limited-CCRT intervention arm were significantly better than passive controls on KABC-II Mental Processing Index (P = 0.04), Sequential Processing (working memory) (P = 0.02) and the Conceptual Thinking subtest (planning/reasoning) (P = 0.02). At one year post-training, the limited CCRT malaria children had more rapid CogState card detection (attention) (P = 0.02), and improved BRIEF Global Executive Index (P = 0.01) as compared to passive controls. Non-malaria children receiving CCRT significantly benefited only on KABC-II Conceptual Thinking (both full- and limited-CCRT; P < 0.01), CogState Groton maze chase and learning (P < 0.01), and CogState card identification (P = 0.05, full CCRT only). Improvements in KABC-II Conceptual Thinking planning subtest for the non-malaria children persisted to one-year follow-up only for the full-CCRT intervention arm. CONCLUSION For severe malaria survivors, limited CCRT improved attention and memory outcomes more than full CCRT, perhaps because of the greater repetition and practice on relevant training tasks in the absence of the performance titration for full CCRT. There were fewer significant cognitive and behavior benefits for the non-malaria children, with the exception of the planning/reasoning subtest of Conceptual Thinking, with stronger full- compared to limited-CCRT improvements persisting to one-year follow-up.
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Affiliation(s)
- Michael J Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA; Department of Neurology & Ophthalmology, Michigan State University, East Lansing, MI, USA.
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University School of Medicine, Kampala, Uganda.
| | - Alla Sikorskii
- Departments of Psychiatry and Statistics & Probability, Michigan State University, East Lansing, MI, USA.
| | | | | | - Kimberley Walhof
- Department of Obstetrics and Gynecology, University of Utah Medical School, Provo, UT, USA.
| | | | - Robert O Opoka
- Department of Paediatrics and Child Health, Makerere University School of Medicine, Kampala, Uganda.
| | - Bruno Giordani
- Departments of Psychiatry, Neurology, Psychology, and School of Nursing, University of Michigan, Ann Arbor, MI, USA.
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Abrams EJ, Ananworanich J, Archary M, Ngongondo M, Brouwers P. Propelling the Pediatric HIV Therapeutic Agenda With Science, Innovation, and Collaboration. J Acquir Immune Defic Syndr 2018; 78 Suppl 1:S32-S39. [PMID: 29994918 PMCID: PMC6044456 DOI: 10.1097/qai.0000000000001747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND A number of well-described obstacles to the pediatric therapeutic agenda have resulted in substantial delays in the introduction of new medications, formulations, strategies, and approaches to treat infants, children, and adolescents living with HIV. SETTING Global landscape. METHODS The authors will provide a summary of current and emerging initiatives to accelerate the pediatric therapeutic agenda including illustrative case studies of innovations and scientific discovery in diagnosis and treatment of very young children with HIV infection. RESULTS The challenges posed by rapid physiologic and developmental changes that characterize the trajectory of childhood as well as the complex regulatory and fiscal milieu of HIV therapeutics have hampered pediatric HIV therapeutic research. Recent efforts to accelerate this agenda include prioritizing agents and formulations, defining dosing by weight bands, applying innovative study designs, synergizing work across research networks to achieve common goals, and the establishment of a global prioritized research agenda. A case study of initiatives to diagnose and effectively treat newborns and infants will illustrate the critical role of basic science research and novel approaches to study design and implementation that are informing global efforts to end AIDS. CONCLUSIONS A pediatric therapeutic agenda informed by basic science and achieved through innovation and global cooperation is essential to achieve an AIDS-free generation.
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Affiliation(s)
- Elaine J. Abrams
- ICAP at Columbia, Mailman School of Public Health, College of Physicians & Surgeons, Columbia University, New York, NY
| | - Jintanat Ananworanich
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Department of Global Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Moherndran Archary
- Paediatric Infectious Diseases Unit, King Edward VIII Hospital, University of KwaZulu Natal, Durban, South Africa
| | | | - Pim Brouwers
- Division of AIDS Research, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
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Mebrahtu H, Simms V, Chingono R, Mupambireyi Z, Weiss HA, Ndlovu P, Malaba R, Cowan FM, Sherr L. Postpartum maternal mental health is associated with cognitive development of HIV-exposed infants in Zimbabwe: a cross-sectional study. AIDS Care 2018; 30:74-82. [PMID: 29848008 DOI: 10.1080/09540121.2018.1468015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study examines the cognitive profiles of infants born to HIV positive mothers in Zimbabwe. Caregivers with HIV exposed infants delivered in 30 clinics in two areas of Zimbabwe were recruited to the study. Of the 574 study participants, 562 caregiver-infant dyads with a biological HIV +ve mother and infant aged 0-24 months were interviewed. All infants were tested by a trained administrator for cognitive development on the Mullen Scales of Early Learning (MSEL). The Edinburgh Postnatal Depression Scale and Parental Stress Index-Short Form were completed by the mothers together with infant and caregiver socioeconomic characteristics. Linear regression models were used to relate cognitive development scores to maternal stress scores, maternal depression scores and infant HIV status adjusting for infant and caregiver characteristics, as well as socioeconomic factors. Higher maternal depression scores were associated with lower overall infant cognitive scores (adjusted mean difference (aMD) = -0.28; CI 95%:-0.50 to -0.06; p = 0.01) and in the expressive language (aMD = -0.14; CI 95%:-0.27 to -0.01; p = 0.04), fine motor skills (aMD = -0.17; CI 95%: -0.33 to -0.01; p = 0.03), gross motor (aMD = -0.22; CI 95%:-0.40 to -0.04; p = 0.02), and visual reception (aMD = -0.22; CI 95%:-0.40 to -0.05; p = 0.01) domains. Higher maternal stress was associated with poorer overall infant cognitive scores (aMD = -0.11; CI 95%:-0.20 to -0.02; p = 0.02) and in the specific domains of expressive language (aMD = -0.07; CI 95%:-0.12 to -0.01; p = 0.01), gross motor skills (aMD = -0.12; CI 95%:-0.18 to -0.05; p < 0.01) and visual reception (aMD = -0.09; CI 95%:-0.16 to -0.02; p = 0.02). Comparisons between the small number of HIV positive infants (n = 16) and the HEU infants (n = 381) showed the latter to have higher mean gross motor scores (50.3 vs. 40.6; p = 0.01). There was no evidence of difference by HIV status in the other MSEL domains or overall mean cognitive scores. Our findings demonstrate the association between maternal mood and stress levels and child cognitive functioning, particularly in expressive language and visual reception development. Although cross sectional data cannot shed light on the direction of this association, the study suggests that interventions to address maternal stress and depression symptoms may prove to be beneficial.
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Affiliation(s)
- Helen Mebrahtu
- a Department of Global Health , University College London , London , UK
| | - Victoria Simms
- b MRC Tropical Epidemiology Group , London School of Hygiene and Tropical Medicine , London , UK
| | - Rudo Chingono
- a Department of Global Health , University College London , London , UK.,c Centre for Sexual Health HIV/AIDS Research (CeSHHAR) , Harare , Zimbabwe
| | - Zivai Mupambireyi
- c Centre for Sexual Health HIV/AIDS Research (CeSHHAR) , Harare , Zimbabwe
| | - Helen A Weiss
- b MRC Tropical Epidemiology Group , London School of Hygiene and Tropical Medicine , London , UK
| | | | - Ricky Malaba
- d World Education Inc./Bantwana (WEI/B) , Harare , Zimbabwe
| | - Frances M Cowan
- c Centre for Sexual Health HIV/AIDS Research (CeSHHAR) , Harare , Zimbabwe.,e Department of International Public Health , Liverpool School of Tropical Medicine , Liverpool , UK
| | - Lorraine Sherr
- a Department of Global Health , University College London , London , UK
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Musindo O, Bangirana P, Kigamwa P, Okoth R, Kumar M. Neurocognitive functioning of HIV positive children attending the comprehensive care clinic at Kenyatta national hospital: exploring neurocognitive deficits and psychosocial risk factors. AIDS Care 2018; 30:618-622. [PMID: 29353495 DOI: 10.1080/09540121.2018.1426829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Children and adolescents are affected in different ways by HIV/AIDS. Neurocognitive deficits are one of the most significant long term effects on HIV infected children and adolescents. Several factors are thought to influence cognitive outcomes and this include immune status, Highly Active Antiretroviral Therapy (HAART), education and social support. The aim of the study was to assess the neurocognitive function of HIV infected children and adolescents and correlate it with psychosocial factors. A cross sectional study was carried out involving a sample of 90 children living with HIV between 8 and 15 years (M = 11.38, SD = 2.06) attending Comprehensive Care Clinic (CCC) at Kenyatta National Hospital (KNH). Samples were selected by using purposive sample technique. Kaufman Assessment Battery for Children-Second Edition was used to assess cognitive function and psychosocial issues were assessed using HEADS-ED. Data was analyzed using SPSS v23 and independent T-tests, Pearson's correlation and linear regression were used. The prevalence of neurocognitive deficits among HIV positive children attending CCC at KNH was 60% with neurocognitive performance of 54 children being at least 2SD below the mean based on the KABC-II scores. There was no significant correlation between mental processing index and CD4 count (Pearson's rho = -0.01, p = 0.39). There was no significant association between Mental Processing Index and viral load (p = 0.056) and early ARV initiation (0.27). Using the HEADS-ED, risks factors related to education (β = -5.67, p = 0.02) and activities and peer support (β = -9.1, p = 0.002) were significantly associated with poor neurocognitive performance. Neurocognitive deficits are prevalent among HIV positive children attending CCC-KNH. This extent of the deficits was not associated with low CD4 count, high viral load or early initiation in HIV care. However, poor school performance and problem with peers was associated with poor neurocognitive performance.
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Affiliation(s)
- Otsetswe Musindo
- a Department of Psychiatry , College of Health Sciences, University of Nairobi , Nairobi , Kenya
| | - Paul Bangirana
- b Department of Psychiatry , College of Health Sciences, Makerere University , Kampala , Uganda
| | - Pius Kigamwa
- a Department of Psychiatry , College of Health Sciences, University of Nairobi , Nairobi , Kenya
| | - Roselyne Okoth
- a Department of Psychiatry , College of Health Sciences, University of Nairobi , Nairobi , Kenya
| | - Manasi Kumar
- a Department of Psychiatry , College of Health Sciences, University of Nairobi , Nairobi , Kenya
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Neuropsychological performance in African children with HIV enrolled in a multisite antiretroviral clinical trial. AIDS 2018; 32:189-204. [PMID: 29112069 DOI: 10.1097/qad.0000000000001683] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE AND DESIGN Children with HIV infection (HIV+) are at neuropsychological risk, but few studies have evaluated this at multiple sites in low-income and middle-income countries. We compared neuropsychological outcomes at enrollment (>5 years age) among HIV+, HIV perinatally exposed uninfected (HEU), and HIV unexposed uninfected (HUU) children from four sub-Saharan countries. METHODS IMPAACT P1060 compared nevirapine versus lopinavir/ritonavir-based antiretroviral treatment (ART) in HIV-infected children 6-35 months of age. The present study (P1104s) enrolled P1060 children at 5-11 years of age and evaluated their neuropsychological performance over 2 years using the Kaufman Assessment Battery for Children, 2nd edition (KABC-II), Tests of Variables of Attention (TOVA), Bruininks-Oseretsky Test, 2nd edition (BOT-2), and parent-reported Behavior Rating Inventory of Executive Function (BRIEF). Cohorts were compared using generalized estimating equations least-squares means adjusted for site, child age and sex, and personal and social characteristics for child and caregiver. RESULTS Six hundred and eleven (246 HIV+, 183 HEU, 182 HUU) of the 615 enrolled at six sites [South Africa (three), Zimbabwe, Malawi, Uganda] were available for analysis. Mean age was 7.2 years, 48% male, 69% in school. Unadjusted and adjusted comparisons were consistent. HIV+ children performed significantly worse than HEU and HUU cohorts on all KABC-II cognitive performance domains and on BOT-2 total motor proficiency (P < 0.001), but not on the BRIEF Global Executive Indices. HUU and HEU cohorts were comparable on cognitive outcomes. HIV+ children initiated on ART before 1 year of age had significantly better BRIEF evaluations (lower scores - fewer behavior problems), compared with those started after (P = 0.03). CONCLUSION Significant cognitive deficits were documented among HIV+ children at school age, even when started on ART at an early age. Earlier HIV treatment, neuropsychological monitoring, and rehabilitative interventions are all needed. Subsequent testing for 2 more years will help further evaluate how HIV infection and exposure affect the developmental trajectory.
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Sherr L, Macedo A, Tomlinson M, Skeen S, Cluver LD. Could cash and good parenting affect child cognitive development? A cross-sectional study in South Africa and Malawi. BMC Pediatr 2017; 17:123. [PMID: 28499423 PMCID: PMC5427556 DOI: 10.1186/s12887-017-0883-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 05/08/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Social protection interventions, including cash grants and care provision have been shown to effectively reduce some negative impacts of the HIV epidemic on adolescents and families. Less is known about the role of social protection on younger HIV affected populations. This study explored the impact of cash grants on children's cognitive development. Additionally, we examined whether combined cash and care (operationalised as good parenting) was associated with improved cognitive outcomes. METHODS The sample included 854 children, aged 5 - 15, participating in community-based organisation (CBO) programmes for children affected by HIV in South Africa and Malawi. Data on child cognitive functioning were gathered by a combination of caregiver report and observer administered tests. Primary caregivers also reported on the economic situation of the family, cash receipt into the home, child and household HIV status. Parenting was measured on a 10 item scale with good parenting defined as a score of 8 or above. RESULTS About half of families received cash (55%, n = 473), only 6% (n = 51) reported good parenting above the cut-off point but no cash, 18% (n = 151) received combined cash support and reported good parenting, and 21% (n = 179) had neither. Findings show that cash receipt was associated with enhanced child cognitive outcomes in a number of domains including verbal working memory, general cognitive functioning, and learning. Furthermore, cash plus good parenting provided an additive effect. Child HIV status had a moderating effect on the association between cash or/plus good parenting and cognitive outcomes. The association between cash and good parenting and child cognitive outcomes remained significant among both HIV positive and negative children, but overall the HIV negative group benefited more. CONCLUSIONS This study shows the importance of cash transfers and good parenting on cognitive development of young children living in HIV affected environments. Our data clearly indicate that combined provision (cash plus good parenting) have added value.
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Affiliation(s)
- Lorraine Sherr
- Research Department of Global Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Ana Macedo
- Research Department of Global Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Skeen
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Lucie Dale Cluver
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Department of Social Policy & Social Intervention, Centre for Evidence-Based Intervention, University of Oxford, Oxford, UK
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Abstract
Combination antiretroviral treatment is associated with clear benefits in HIV-positive subjects, and is also effective in the central nervous system (CNS), meaning HIV-associated dementia is now an uncommon event. Nevertheless, a significant number of patients show symptoms of neurocognitive impairment which may negatively affect their quality of life. Although several risk factors for HIV-associated neurocognitive disorders have been identified, there is no clear recommendation for their prevention and management. In this review, the penetration of drugs into the cerebrospinal fluid/CNS is discussed as well as the viral and clinical consequences associated with higher/lower compartmental exposure. We also review the potential interventions according to the currently identified underlying mechanisms, including persistent CNS immune activation, legacy effects, low-level viral replication and escape, co-morbidities, and antiretroviral-associated direct and indirect 'neurotoxicity'. Adjunctive therapies and interventions (including neuro-rehabilitation) are then briefly discussed. The treatment of HIV infection in the CNS is a complex area of therapeutics requiring multidisciplinary interventions and further study.
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Affiliation(s)
- A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy.
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy
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Boivin MJ, Ruisenor-Escudero H, Familiar-Lopez I. CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care. Curr HIV/AIDS Rep 2016; 13:318-327. [PMID: 27783207 PMCID: PMC5107125 DOI: 10.1007/s11904-016-0342-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
There is growing concern that although the more severe forms of HIV-associated neurologic deficits are reduced following highly active anti-retroviral therapy (HAART), mild to moderate cognitive disorders may persist for years after HAART initiation and this may occur despite complete plasma viral suppression. According to the UNAIDS 2014 report, there were 3.2 million children living with HIV around the world at the end of 2013 and 91 % of these resided in sub-Saharan Africa. In the same year, only 24 % of children who needed antiretroviral treatment (ART) received it and 190,000 children died of AIDS-related illnesses. We propose that behavioral interventions are needed in combination with medical treatment and care in order to fully address the needs of children and adolescents in Africa living with HIV. In early childhood, caregiver training programs to enhance the developmental milieu of the child with HIV can enhance their cognitive and social development and that such interventions are both feasible and well-accepted by the local population. For school-age children, computerized cognitive rehabilitation training can be an entertaining and engaging way to improve attention, working memory, and problem solving skills for children with HIV. Further dissemination and implementation science work is needed for arriving at cost-effective strategies for scaling up such behavioral interventions in African resource-constrained settings, given that the vast majority of HIV-affected children and youth worldwide presently live in sub-Saharan Africa.
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Affiliation(s)
- Michael J. Boivin
- Department of Psychiatry and the Department of Neurology & Ophthalmology, Michigan State University Department of Psychiatry, University of Michigan, 909 Fee Road, Rm 321 West Fee Hall, East Lansing Michigan 48894 USA, Phone: 765 506-2163, FAX: 517 432-2893
| | - Horacio Ruisenor-Escudero
- Department of Psychiatry, Michigan State University, 909 Fee Road, Rm 321 West Fee Hall, East Lansing, Michigan 48894 USA, Phone: 517 432-4204, FAX: 517 432-2893
| | - Itziar Familiar-Lopez
- Department of Psychiatry, Michigan State University, 909 Fee Road, Rm 321 West Fee Hall, East Lansing, Michigan 48894 USA, Phone: 517 432-4204, FAX: 517 432-2893
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