First name
Tyler
Middle name
M
Last name
Moore

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

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

The impact of disease-related knowledge on perceptions of stigma among patients with Hepatitis C Virus (HCV) infection.

Year of Publication

2021

Number of Pages

e0258143

Date Published

2021

ISSN Number

1932-6203

Abstract

<p>Most patients with hepatitis C virus (HCV) infection perceive some degree of disease-related stigma. Misunderstandings about diseases may contribute to disease-related stigma. The objective of this study was to evaluate patient-level knowledge about HCV infection transmission and natural history and its association with HCV-related stigma among HCV-infected patients. We conducted a cross-sectional survey study among 265 patients with HCV in Philadelphia using the HCV Stigma Scale and the National Health and Nutrition Examination Survey (NHANES) Hepatitis C Follow-up Survey (2001-2008). The association between HCV knowledge and HCV-related stigma was evaluated via linear regression. Overall knowledge about HCV transmission and natural history was high, with &gt;80% of participants answering ≥9 of 11 items correctly (median number of correct responses, 9 [82%]), HCV-related knowledge was similar between HIV/HCV-coinfected and HCV-monoinfected participants (p = 0.30). A higher level of HCV-related knowledge was associated with greater perceived HCV-related stigma (β, 2.34 ([95% CI, 0.51-4.17]; p = 0.013). Results were similar after adjusting for age, race, ethnicity, HIV status, education level, stage of HCV management, time since diagnosis, and history of injection drug use. In this study, increased HCV-related knowledge was associated with greater perceptions of HCV stigma. Clinicians may consider allotting time to address common misconceptions about HCV when educating patients about HCV infection, which may counterbalance the stigmatizing impact of greater HCV-related knowledge.</p>

DOI

10.1371/journal.pone.0258143

Alternate Title

PLoS One

PMID

34610030

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

Development of a computerised neurocognitive battery for children and adolescents with HIV in Botswana: study design and protocol for the Ntemoga study.

Year of Publication

2020

Number of Pages

e041099

Date Published

2020 Aug 26

ISSN Number

2044-6055

Abstract

<p><strong>INTRODUCTION: </strong>Neurodevelopmental delays and cognitive impairments are common in youth living with HIV. Unfortunately, in resource-limited settings, where HIV infection impacts millions of children, cognitive and neurodevelopmental disorders commonly go undetected because of a lack of appropriate assessment instruments and local expertise. Here, we present a protocol to culturally adapt and validate the Penn Computerized Neurocognitive Battery (PennCNB) and examine its validity for detecting both advanced and subtle neurodevelopmental problems among school-aged children affected by HIV in resource-limited settings.</p>

<p><strong>METHODS AND ANALYSIS: </strong>This is a prospective, observational cohort study. The venue for this study is Gaborone, Botswana, a resource-limited setting with high rates of perinatal exposure to HIV and limited neurocognitive assessment tools and expertise. We aim to validate the PennCNB in this setting by culturally adapting and then administering the adapted version of the battery to 200 HIV-infected, 200 HIV-exposed uninfected and 240 HIV-unexposed uninfected children. A series of analyses will be conducted to examine the reliability and construct validity of the PennCNB in these populations.</p>

<p><strong>ETHICS AND DISSEMINATION: </strong>This project received ethical approval from local and university Institutional Review Boards and involved extensive input from local stakeholders. If successful, the proposed tools will provide practical screening and streamlined, comprehensive assessments that could be implemented in resource-limited settings to identify children with cognitive deficits within programmes focused on the care and treatment of children affected by HIV. The utility of such assessments could also extend beyond children affected by HIV, increasing general access to paediatric cognitive assessments in resource-limited settings.</p>

DOI

10.1136/bmjopen-2020-041099

Alternate Title

BMJ Open

PMID

32847928

Title

Determinants of Stigma among Patients with Hepatitis C Virus (HCV) Infection.

Year of Publication

2020

Date Published

2020 Jun 05

ISSN Number

1365-2893

Abstract

<p>Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV treatment and elimination. The determinants of HCV-related stigma, including the impacts of stage of HCV treatment (i.e., spontaneously-cleared; diagnosed, untreated; previously treated, not cured; currently being treated; treated, cured) and coinfection with human immunodeficiency virus (HIV), remain unknown. To address these gaps, we conducted a cross-sectional study among patients with a history of HCV infection (n=270) at outpatient clinics in Philadelphia from July 2018 - May 2019. We evaluated stigma using the validated HCV Stigma Scale, adapted from the Berger HIV Stigma Scale. Associations among HCV-related stigma and hypothesized demographic, behavioral, and clinical risk factors were evaluated by multivariable linear regression. Most participants (95.5%) experienced HCV-related stigma. Mean stigma scores did not differ significantly between HCV-monoinfected and HIV/HCV-coinfected participants (P=0.574). However, we observed significant interactions between HIV status and multiple determinants; therefore, we stratified analyses by HIV status. Among HIV/HCV-coinfected participants, previous HCV treatment without cure, female gender, Hispanic/Latino ethnicity, and some college education were significantly associated with higher HCV-stigma scores. An annual income of $10,000-$40,000 was associated with significantly lower stigma scores. No significant associations were observed among HCV-monoinfected participants. We found that most participants experienced stigma associated with HCV diagnosis. While stigma scores were similar between HCV-monoinfected and HIV/HCV-coinfected participants, the determinants associated with HCV stigma differed by HIV status. Understanding how experiences of stigma differs between HCV-monoinfected and HIV/HCV-coinfected patients may aid in the development of targeted interventions to address the HCV epidemic.</p>

DOI

10.1111/jvh.13343

Alternate Title

J. Viral Hepat.

PMID

32500618

Title

Validation of a modified Berger HIV stigma scale for use among patients with hepatitis C virus (HCV) infection.

Year of Publication

2020

Number of Pages

e0228471

Date Published

2020

ISSN Number

1932-6203

Abstract

<p><strong>BACKGROUND: </strong>Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV prevention, treatment, and elimination. To date, no validated instrument exists to measure patients' experiences of HCV stigma. This study aimed to revise the Berger (2001) HIV stigma scale and evaluate its psychometric properties among patients with HCV infection.</p>

<p><strong>METHODS: </strong>The Berger HIV stigma scale was revised to ask about HCV and administered to patients with HCV (n = 270) in Philadelphia, Pennsylvania. Scale reliability was evaluated as internal consistency by calculating Cronbach's alpha. Exploratory factor analysis was performed to evaluate construct validity by comparing item clustering to the Berger HIV stigma scale subscales. Item response theory was employed to further evaluate individual items and to calibrate items for simulated computer adaptive testing sessions in order to identify potential shortened instruments.</p>

<p><strong>RESULTS: </strong>The revised HCV Stigma Scale was found to have good reliability (α = 0.957). After excluding items for low loadings, the exploratory factor analysis indicated good construct validity with 85% of items loading on pre-defined factors. Analyses strongly suggested the predominance of an underlying unidimensional factor solution, which yielded a 33-item scale after items were removed for low loading and differential item functioning. Adaptive simulations indicated that the scale could be substantially shortened without detectable information loss.</p>

<p><strong>CONCLUSIONS: </strong>The 33-item HCV Stigma Scale showed sufficient reliability and construct validity. We also conducted computer adaptive testing simulations and identified shortened six- and three-item scale alternatives that performed comparably to the original 40-item scale.</p>

DOI

10.1371/journal.pone.0228471

Alternate Title

PLoS ONE

PMID

32023310

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