First name
Elizabeth
Middle name
D
Last name
Lowenthal

Title

Impact of COVID-19 on Adolescent HIV Prevention and Treatment Services in the AHISA Network.

Year of Publication

2022

Number of Pages

1-10

Date Published

12/2022

ISSN Number

1573-3254

Abstract

We investigated perceived impacts of COVID-19 on the delivery of adolescent HIV treatment and prevention services in sub-Saharan Africa (SSA) by administering a survey to members of the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) from February to April 2021. We organized COVID-19 impacts, as perceived by AHISA teams, under three themes: service interruptions, service adjustments, and perceived individual-level health impacts. AHISA teams commonly reported interruptions to prevention programs, diagnostic testing, and access to antiretroviral therapy (ART). Common service adjustments included decentralization of ART refills, expanded multi-month ART distribution, and digital technology use. Perceived individual-level impacts included social isolation, loss to follow-up, food insecurity, poverty, and increases in adolescent pregnancies and sexually transmitted infections. The need for collaboration among stakeholders were commonly cited as lessons learned by AHISA teams. Survey findings highlight the need for implementation science research to evaluate the effects of pandemic-related HIV service adaptations in SSA.

DOI

10.1007/s10461-022-03959-0

Alternate Title

AIDS Behav

PMID

36574183

Title

Test-Retest Reliability of a Computerized Neurocognitive Battery in School-Age Children with HIV in Botswana.

Year of Publication

2022

Date Published

08/2022

ISSN Number

1873-5843

Abstract

Human immunodeficiency virus (HIV) infection is prevalent among children and adolescents in Botswana, but standardized neurocognitive testing is limited. The Penn Computerized Neurocognitive Battery (PennCNB) attempts to streamline evaluation of neurocognitive functioning and has been culturally adapted for use among youth in this high-burden, low-resource setting. However, its reliability across measurements (i.e., test-retest reliability) is unknown. This study examined the test-retest reliability of the culturally adapted PennCNB in 65 school-age children (age 7-17) living with HIV in Botswana. Intraclass correlation coefficients (ICCs) for PennCNB summary scores (ICCs > 0.80) and domain scores (ICCs = 0.66-0.88) were higher than those for individual tests, which exhibited more variability (ICCs = 0.50-0.82), with the lowest reliability on memory tests. Practice effects were apparent on some measures, especially within memory and complex cognition domains. Taken together, the adapted PennCNB exhibited adequate test-retest reliability at the domain level but variable reliability for individual tests. Differences in reliability should be considered in implementation of these tests.

DOI

10.1093/arclin/acac066

Alternate Title

Arch Clin Neuropsychol

PMID

35988538

Title

Impact of COVID-19 on Adolescent HIV Prevention and Treatment Research in the AHISA Network.

Year of Publication

2022

Date Published

09/2022

ISSN Number

1573-3254

Abstract

Members of the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) network conduct research aiming to close gaps between what is known to be impactful across the HIV prevention and treatment cascade, and services delivered to optimize outcomes for adolescents/young adults (AYA) in high HIV-prevalence settings. The COVID-19 pandemic introduced new challenges which threaten to exacerbate care and access disparities. We report results of a survey among AHISA teams with active AYA HIV research programs in African countries to determine how the pandemic has impacted their efforts. Results highlighted the detrimental impact of the pandemic on research efforts and the expanded need for implementation research to help provide evidence-based, context-specific pandemic recovery support. Key lessons learned included the viability of remote service delivery strategies and other innovations, the need for adaptive systems that respond to evolving contextual needs, and the need for organized documentation plans, within empathic and flexible environments.

DOI

10.1007/s10461-022-03811-5

Alternate Title

AIDS Behav

PMID

36094636

Title

Impact of COVID-19 on Adolescent HIV Prevention and Treatment Research in the AHISA Network.

Year of Publication

2022

Date Published

09/2022

ISSN Number

1573-3254

Abstract

Members of the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) network conduct research aiming to close gaps between what is known to be impactful across the HIV prevention and treatment cascade, and services delivered to optimize outcomes for adolescents/young adults (AYA) in high HIV-prevalence settings. The COVID-19 pandemic introduced new challenges which threaten to exacerbate care and access disparities. We report results of a survey among AHISA teams with active AYA HIV research programs in African countries to determine how the pandemic has impacted their efforts. Results highlighted the detrimental impact of the pandemic on research efforts and the expanded need for implementation research to help provide evidence-based, context-specific pandemic recovery support. Key lessons learned included the viability of remote service delivery strategies and other innovations, the need for adaptive systems that respond to evolving contextual needs, and the need for organized documentation plans, within empathic and flexible environments.

DOI

10.1007/s10461-022-03811-5

Alternate Title

AIDS Behav

PMID

36094636

Title

Predictive Validity of a Computerized Battery for Identifying Neurocognitive Impairments Among Children Living with HIV in Botswana.

Year of Publication

2022

Date Published

2022 Feb 19

ISSN Number

1573-3254

Abstract

<p>Children living with&nbsp;HIV (HIV+) experience increased risk of&nbsp;neurocognitive deficits, but standardized&nbsp;cognitive testing is limited in low-resource, high-prevalence settings. The Penn Computerized Neurocognitive Battery (PennCNB) was adapted for use in Botswana.&nbsp;This&nbsp;study evaluated the criterion validity of a locally adapted version of the PennCNB among a cohort of HIV+ individuals aged 10-17&nbsp;years in Botswana.&nbsp;Participants completed the PennCNB and a comprehensive professional consensus assessment consisting of pencil-and-paper psychological assessments, clinical interview, and review of academic performance. Seventy-two&nbsp;participants were&nbsp;classified as cases (i.e., with cognitive impairment; N = 48) or controls (i.e., without cognitive impairment; N = 24). Sensitivity, specificity, positive predictive value, negative predictive value, and the area under receiver operating&nbsp;characteristic curves were&nbsp;calculated. Discrimination was acceptable, and prediction improved as the threshold for PennCNB impairment was less conservative. This research contributes to the validation of the PennCNB for use among children affected by HIV in Botswana.</p>

DOI

10.1007/s10461-022-03620-w

Alternate Title

AIDS Behav

PMID

35182282

Title

Medical stakeholder perspectives on implementing a computerized battery to identify neurocognitive impairments among youth in Botswana.

Year of Publication

2021

Number of Pages

1-9

Date Published

2021 Oct 18

ISSN Number

1360-0451

Abstract

<p>HIV infection and exposure, common in Sub-Saharan Africa, are associated with pediatric neurocognitive impairment. Cognitive screening can identify impairments, but it is rarely used in this setting. The Penn Computerized Neurocognitive Battery (PennCNB), an evidence-based cognitive screening tool, was adapted for use in Botswana. To facilitate future implementation, 20 semi-structured interviews were conducted to elicit key stakeholders' perspectives on factors likely to be related to successful uptake of the PennCNB in clinical settings. An integrated analytic approach combining constructs from the Consolidated Framework for Implementation Research and modified grounded theory was used. Results underscore the need for cognitive screening in Botswana and the acceptability of the PennCNB. Implementation barriers include limited time and resources, whereas facilitators include standard procedures for introducing new tools into medical settings and for training implementers. Recommended implementation strategies include integrating screening into the existing workflow, implementing the tool in the medical and educational sectors, and targeting selection of children for assessment. This research addresses the research-to-practice gap by engaging in pre-implementation inquiry and designing for implementation. Results will inform the development of strategies to maximize the likelihood of successful implementation of the PennCNB to identify neurocognitive impairment in children in this high-need setting.</p>

DOI

10.1080/09540121.2021.1990202

Alternate Title

AIDS Care

PMID

34663144

Title

Structural validity of a computerized neurocognitive battery for youth affected by human immunodeficiency virus in Botswana.

Year of Publication

2021

Date Published

2021 Sep 13

ISSN Number

1939-134X

Abstract

<p>Children born to mothers infected with the human immunodeficiency virus (HIV) during pregnancy experience increased risk of neurocognitive impairment. In Botswana, HIV infection is common among youth, but standardized cognitive screening is limited. The Penn Computerized Neurocognitive Battery (PennCNB), a tool that streamlines evaluation of neurocognitive functioning, was culturally adapted for use among youth in this high-burden, low-resource setting. The present study examined the structural validity of the culturally adapted PennCNB. A cohort of 7-17-year-old children living with HIV (HIV +) and HIV-exposed-uninfected (HEU) children were enrolled from the Botswana-Baylor Children's Clinical Centre of Excellence in Gaborone, Botswana. Confirmatory and exploratory factor analyses were performed on speed, accuracy, and efficiency measures for 13 PennCNB tests. Fit of the confirmatory factor analysis was acceptable, which supports the design of the battery measuring four neurocognitive domains: Executive functioning, episodic memory, complex cognition, and sensorimotor/processing speed. However, the model revealed high interfactor correlation. Exploratory factor analysis suggested that tests assessing executive functioning and sensorimotor/processing speed clustered together rather than forming differentiable factors. Overall, this research provides valuable insight into the structural validity of a neurocognitive battery adapted for use in a non-Western setting, suggesting that the PennCNB could serve as a useful tool for the assessment of neurocognitive function in Botswana and, potentially, other resource-limited settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).</p>

DOI

10.1037/pas0001066

Alternate Title

Psychol Assess

PMID

34516163

Title

Reasons for discordance between antiretroviral adherence measures in adolescents.

Year of Publication

2021

Number of Pages

1-9

Date Published

2021 Aug 23

ISSN Number

1360-0451

Abstract

<p>Adolescents with suboptimal medication taking may deceive caregivers about non-adherence. We conducted a 5-year longitudinal study of adolescents monitored simultaneously with both easily manipulated (e.g., self-report) and hard to manipulate (e.g., microelectronic data) strategies. Adolescents with repeatedly high adherence on the former and low adherence on the latter were invited along with their parental figures ("parents") to participate. We conducted focus groups and semi-structured interviews, separately for adolescents and parents, to elucidate drivers of discordant measures. Forty-seven adolescents and 26 parents participated in focus groups and 4 adolescents were interviewed. Adolescents described hiding pills, discarding pills, and lying. Their motivations included fear of disappointing those who care about them, desire to avoid admonishment by parents and clinic staff, and desire to avoid remedial adherence counseling. Both adolescents and parents considered negative feedback for prior poor adherence to be key motivation to hide current poor adherence from clinic staff. Providing positive feedback for truth-telling, rather than for "evidence" of excellent adherence, might help adolescent patients and their parents to develop stronger treatment alliances with each other and with clinic staff. Such alliances would allow adherence interventions to be better targeted and more fruitful in increasing adherence.</p>

DOI

10.1080/09540121.2021.1968998

Alternate Title

AIDS Care

PMID

34424796

Title

Effectiveness of Deworming with Single-Dose Albendazole for Preschool-Aged Children in the Dominican Republic.

Year of Publication

2021

Number of Pages

2333794X211002949

Date Published

2021

ISSN Number

2333-794X

Abstract

<p><em>Background</em>. The World Health Organization recommends biannual deworming with single-dose albendazole for all children over 1 year in regions where soil-transmitted helminths (STH) are endemic. There are limited data from the Dominican Republic (DR) on the effectiveness of deworming programs.&nbsp;<em>Methods</em>. Between January and June 2019, we enrolled 63 preschool-aged children at a community clinic in the DR. Participants received albendazole at enrollment. Stool samples were collected and examined for parasites at enrollment, 2 to 4 and 12 to 16 weeks post-albendazole. Caregivers were surveyed on home hygiene practices and children's symptoms.&nbsp;<em>Findings</em>. At enrollment, 1 or more parasites were noted in 89% of samples.&nbsp;<em>Ascaris lumbricoides</em>&nbsp;(68%) was the most common species, followed by&nbsp;<em>Entamoeba histolytica</em>&nbsp;(35%) and&nbsp;<em>Giardia intestinalis</em>&nbsp;(8%). Two-to-four weeks post-albendazole, fewer than half of those with&nbsp;<em>A. lumbricoides</em>&nbsp;infections at baseline had cleared the infection. STH symptoms significantly improved between enrollment and 2 to 4 weeks. By 12 to 16 weeks after treatment,&nbsp;<em>A. lumbricoides</em>&nbsp;infections were as high as baseline.&nbsp;<em>Interpretation</em>. Although limited by size and available technology, our study contributes data on STH in the DR. Single-dose deworming with albendazole did not reduce&nbsp;<em>Ascaris lumbricoides</em>&nbsp;infections in our sample. As STH are the most common neglected tropical diseases and negatively impact children's health globally, further studies on both effective deworming programs and interventions to prevent STH are needed.</p>

DOI

10.1177/2333794X211002949

Alternate Title

Glob Pediatr Health

PMID

33796636

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