Abstract
Background: People living with HIV are at risk of developing HIV-associated neurocognitive disorders (HAND) which adversely affects their quality of life. Routine screening of HAND in HIV care is recommended to identify subtle changes in cognitive functioning and allow for early interventions. However, HAND detection is rarely done in sub-Saharan Africa (SSA), partly due to a lack of adequately standardized screening tools. This review was conducted to identify the commonly used screening tools for HAND in SSA and document their psychometric properties and diagnostic accuracy.Methods:We searched Ovid Medline, PsycINFO and Web of Sciences databases for empirical studies published from 1/1/1980 to 31/8/2018 on HAND among adults living with HIV in SSA.Results:We identified 14 eligible studies, of which 9 were from South Africa. The International HIV Dementia Scale (IHDS) was the most frequently reported tool, being used in more than half of the studies. However most studies only reported the diagnostic accuracy of this and other tools, with specificity ranging from 37% to 81% and sensitivity ranging from 45% to 100%. Appropriate data on construct validity and reliability of tools was rarely documented. Although most tools performed well in screening for severe forms of HAND, they lacked sensitivity and specificity for moderate forms of HAND. NeuroScreen, one of the newer tools, yielded good diagnostic accuracy in its initial evaluation in South Africa (81% to 93% sensitivity and 71% to 81% specificity).Conclusions:This review identified a lack of adequately standardized and contextually relevant HAND screening tools in SSA. Most screening tools for HAND used in SSA possess inadequate psychometric properties and diagnostic accuracy. There is a need for further validation of existing tools and development of new tools to make them sensitive and specific enough to identify both severe and moderate forms of HAND in SSA.
Highlights
With the advent of highly active antiretroviral therapy (HAART), the 25 million people living with HIV-1/AIDS in sub-Saharan Africa (SSA) have the potential for a near-normal life expectancy[1,2,3]
The search strategy was formulated by two reviewers (PNM and AA) and comprised of the following terms combined with Boolean operators: HIV-associated neurocognitive disorders OR cognitive impairment OR neurocognitive impairment OR neurological complications AND HIV OR HIV-1 OR HIV/AIDS AND adults OR youth OR older people AND Africa OR sub-Saharan Africa
The exclusion criteria are: i) non-empirical studies; ii) studies using other methods for screening HIV-associated neurocognitive disorders (HAND) apart from brief screening; iii) studies published in other languages other than English; iv) studies not conducted among adults, and v) studies carried out outside SSA
Summary
With the advent of highly active antiretroviral therapy (HAART), the 25 million people living with HIV-1/AIDS in sub-Saharan Africa (SSA) have the potential for a near-normal life expectancy[1,2,3]. The diagnosis of HAND is based on the evaluation of key cognitive domains including executive functioning, episodic memory, motor skills, and speed of information processing, language, working memory, and sensory perception according to the Frascati criteria[4]. These criteria consider the extent to which the cognitive impairment impacts the person’s performance on activities of daily living
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