Neurocognitive impairment (NCI) is one of the most common clinical conditions seen in HIV, affecting as many as 70% of infected individuals, including those on antiretroviral therapy (ART) and with well-controlled viremia. The NCI seen in HIV has significant medical, functional, and public health consequences (e.g., problems adhering to ART), but often goes undetected in the clinical setting. Routine screening for HIV-related NCI can enhance provider-patient communication to help patients with NCI better manage their ART adherence and other health outcomes, but doing so faces challenges. For instance, most screening tools for NCI in HIV clinics are paper-and-pencil tests prone to administration and scoring errors that require highly trained personnel to administer, score and interpret, require additional equipment, and are not well-suited for modern clinics utilizing electronic medical records. To address this public health and medical practice gap, we have developed an mHealth tool to make screening more accessible and sustainable in the modern clinical setting. NeuroScreen is a brief, easy-to-use NCI screening test application (app) for Android mobile devices designed to be administered by a wide range of non-expert healthcare personnel. The app is highly automated (e.g., does not require any record keeping or scoring) with standardized instructions ensuring consistent administrations each and every time with minimal training. NeuroScreen is ultra-portable (i.e., usable in any clinic exam room, remote and rural settings, or during home visits) and totally self-contained (i.e., no need for paper forms, pens, stopwatches, or other apparatuses). Results from NeuroScreen are available immediately and can be transmitted electronically to a variety of end-users, such as primary care providers, HIV specialists and/or electronic medical records, as well as to databases for population level monitoring. This study will assess the usability and acceptability of a tablet-based NeuroScreen by HIV care providers of differing expertise levels (e.g., physicians, nurses, and case managers), and identify provider- and clinic-level facilitators and barriers to integrating this mHealth tool into clinical practice. The study will then evaluate NeuroScreen's accuracy to detect mild NCI in 182 HIV-infected adults with NCI (n=91) and without NCI (n=91). With an easy-to-use and accurate tool to detect NCI and well-suited for clinics using and moving towards electronic medical systems, early detection and on-going monitoring of impairment could be realized and help healthcare providers communicate more effectively with patients about their treatment and care, make better referrals, and offer tailored ART adherence interventions and strategies as well as HIV prevention services. Furthermore, NeuroScreen offers health systems a viable method to collect large quantities of neurocognitive data suited to population level epidemiological research and other studies utilizing big data. An mHealth tool, like NeuroScreen, could be easily modified for use in other disease populations and regions of the world that rely on task-shifting due to very limited healthcare resources.
Neurocognitive impairment has significant medical and behavioral consequences and is highly prevalent among people living with HIV. Current screening tests for it are not well-suited for resource limited clinics that are moving towards digital medical records as most current screening tests: are paper-and-pencil based (with results not easily and efficiently integrated into electronic databases), rely on specialized equipment and proprietary test forms, require the use of highly trained personnel to administer, score and interpret, are prone to administration and scoring human errors, and lack sensitivity to detect the most common mild impairment. Offering HIV providers and clinics an mHealth tool that automates the neuropsychological testing to detect neurocognitive impairment using the computing power, touchscreen interactivity, network connectivity, and ultra-portability of mobile technologies can help make screening acceptable and sustainable in HIV clinics using and moving towards electronic medical records, help establish a large database of patient neurocognitive performance well-suited for epidemiological research and meta-analyses, help providers detect impairment earlier, communicate more effectively with patients about the impact of impairment and ways to minimize it, offer tailored health improvement and prevention interventions, make better referrals, and holds promise for improving both individual and public health.
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| Robbins, Reuben N; Gouse, Hetta; Brown, Henry G et al. (2018) A Mobile App to Screen for Neurocognitive Impairment: Preliminary Validation of NeuroScreen Among HIV-Infected South African Adults. JMIR Mhealth Uhealth 6:e5 |
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