Abstract
The prevalence of HIV-associated neurocognitive disorders necessitates community-based screening. In recent years, progress has been made in developing more localised comparative data for use in such screening on the African continent. These studies used measurements that are considered fair, easily accessible, and quick to administer. However, the variance in available international data limits their usefulness and poses a risk to the appropriate streaming of individuals. Here, examples are presented of variance in both cross-national and local demographic screening and neuropsychological test scores, with the aim of cautioning practitioners against undue reliance on general African data for classification of individuals. Recommendations are provided for the development of appropriate norms, specific to local communities.
 
 S Afr J HIV Med 2013;14(1):17-19. DOI:10.7196/SAJHIVMED.855
Highlights
South Africa (SA) is home to the world’s largest population of people living with HIV and AIDS (PLWHA), with an estimated HIV prevalence of 16.9% among SA adults in 2008.[1]. Recent figures suggest that 17 - 25% of HIV patients in SA display cognitive impairment,[2,3] the diagnosis of which is largely dependent on the deviation of test scores from standardised norms
HIV-associated neurocognitive disorders (HANDs) are diagnosed using the Frascati model,[4] which requires neuropsychological scores to be compared with normative data using standard deviation (SD) as an indicator of impairment
The International HIV Dementia Scale (IHDS) and Grooved Pegboard (GP) are arguably the most widely used instruments for HAND screening in limited-resource communities,[5] and these have been shown to differentiate between the HIV statuses of asymptomatic patients in sub-Saharan Africa.[6,7]
Summary
Data from the IHDs and GP tests, and from the rest of the World Health Organization (WHO) HIV battery, have been reported from various sites in sub-Saharan Africa This is positive progress, as the developing world norms differ from those of industrialised countries,[8] and practitioners may need to use comparative data from Africa when no local data are available. The range of the IHDS memory recall subtest differs noticeably between different demographic subgroups within one location.[12] The GP-non-dominant hand test (GP-NDH) differs significantly across countries This is an important HAND screening mechanism, and the variance in published data creates difficulties for interpretation and further streaming. The Digit Symbol Modalities Test (DSMT) differs further by an SD of ±2 between countries
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