Screening for HIV-Associated Neurocognitive Disorder (HAND) in Adults Aged 50 and Over Attending a Government HIV Clinic in Kilimanjaro, Tanzania. Comparison of the International HIV Dementia Scale (IHDS) and IDEA Six Item Dementia Screen

Abstract

Validated screening tools for HIV-associated neurocognitive disorders (HAND) are lacking for the newly emergent ageing population of people living with HIV (PLWH) in sub-Saharan Africa (SSA). We aimed to validate and compare diagnostic accuracy of two cognitive screening tools, the International HIV dementia scale (IHDS), and the Identification and Interventions for Dementia in Elderly Africans (IDEA) screen, for identification of HAND in older PLWH in Tanzania. A systematic sample of 253 PLWH aged ≥ 50 attending a Government clinic in Tanzania were screened with the IHDS and IDEA. HAND were diagnosed by consensus American Academy of Neurology (AAN) criteria based on detailed clinical neuropsychological assessment. Strict blinding was maintained between screening and clinical evaluation. Both tools had limited diagnostic accuracy for HAND (area under the receiver operating characteristic (AUROC) curve 0.639-0.667 IHDS, 0.647-0.713 IDEA), which was highly-prevalent (47.0%). Accurate HAND screening tools for older PLWH in SSA are needed. Keywords HIV • Older adults • Sub-Saharan Africa • Cognitive impairment • Screening • IHDS Resumen Faltan pruebas cognitivas válidas para los trastornos neurocognitivos asociados al VIH (según sus siglas en inglés, HIV-Associated Neurocognitive Disorder (HAND) en la población emergente de personas mayores que viven con el VIH en el África subsahariana. Nuestro objetivo era validar y comparar la precisión diagnóstica de dos pruebas cognitivas, la escala internacional de demencia por VIH (según sus siglas en ingles International HIV dementia scale (IHDS) y la prueba 'IDEA',

Evaluation of a low-resource screening strategy for ophthalmic pathologies and associated neurological morbidity in an older Tanzanian HIV-positive population

“…HAND was diagnosed by consensus using AAN 2007 gold standard criteria 5 based on neuropsychological battery measures validated for cross-cultural use by the WHO, clinical/neurological examination findings, to determine if other psychiatric disorders better explained cognitive performance, and a collateral history from a close relative or friend. All participants underwent additional detailed locally-validated low-literacy neuropsychological tests of cortical function, the details of which have previously been published 6 . Domains assessed included working memory, verbal memory (learning, delayed recall and recognition memory), fine motor control, motor speed, visuoconstruction, executive function and comprehension.…”

“…Practice trials and errors were managed according to a standardized protocol and tests selected were validated locally and/or in low literacy SSA settings. Neuropsychological test results were compared to performance means for those with and without 4 years of formal education generated in 2016 from a comparison group of similar age and education level attending the ophthalmology outpatient department of MRRH 6 , 21 . The collateral history and all clinical and neuropsychological information was used for a multi-disciplinary discussion of each participant by the research team to confirm diagnoses and record a detailed case summary.…”

“…Screening for, and identification of HAND are currently challenging, in SSA and elsewhere. Difficulties include shortage of neurology and psychiatry specialist services in SSA, lack of accurate brief screening measures 6 and current consensus diagnostic criteria requiring detailed neuropsychological assessment, impractical in busy clinical settings. Additionally, the use of mobile technologies to help address health and human resource shortages in low-resource settings is a recent and expanding area of research and has previously been evaluated for use in remote grading of ophthalmic disease in SSA 7 .…”

The Prevalence And Outcomes Of Depression In Older HIV-Positive Adults In Northern Tanzania: A Longitudinal Study

“…The primary purpose of the baseline study was identification and screening of HIVassociated neurocognitive disorders (HAND) and a detailed description of recruitment and baseline assessment has previously been published (16). In brief, a systematic sample (every third eligible individual) was recruited March-May 2016.…”

“…Detailed HIV-disease severity, e.g. CD4 count or viral load, and comorbidity data were obtained from standardised clinic records as previously reported (16). Other demographic data were self-reported and corroborated by informants where necessary.…”