A Mobile App for LMIC Lay Health Workers to Screen for Neurocognitive Impairment

Principal Investigator: 

Funding Agency:

National Institute of Child Health and Human Development (NICHD)

Collaborating Institution: 

University of Cape Town, Department of Psychiatry and Mental Health

Study Location:

Cape Town, South Africa

Description:

With 6.1 million HIV-infected individuals, South Africa is a low-to-middle income country (LMIC) with the world’s largest population of people living with HIV. To address the resulting shortages in healthcare personnel, South Africa uses a task-shifting strategy in which lay health workers provide components of HIV care. Neurocognitive impairment (NCI) is one of the most common sequelae and comorbid conditions of HIV infection and has significant medical, functional, and public health consequences. NCI affects over half of HIV-infected individuals, yet often goes undetected in the clinical setting. Although – as in other chronic diseases – routine screening for NCI in HIV can enhance provider-patient communication to promote medication adherence and positive health outcomes, it faces numerous challenges, including the need for special equipment and highly trained personnel to administer, score and interpret screening tests. Mobile technology can offer a solution to this critical public health and medical care challenge by facilitating routine screening for NCI in HIV and other chronic illnesses. To this end, we developed NeuroScreen, a brief, easy-to-use NCI screening test app for Android devices, designed to be administered by a wide range of non-expert healthcare personnel in clinical settings.

The app is standardized and highly automated, requires minimal training to administer, and does not require record-keeping or scoring. It can be used in clinic exam rooms, remote rural settings, and/or home visits and requires no paper forms, stopwatches, or other equipment. NeuroScreen results are available immediately and can be transmitted electronically to a variety of “end-users,” such as primary care providers, HIV or other specialists, and/or electronic medical records. The proposed study will: (1) adapt NeuroScreen for administration by South African, Xhosa-speaking lay counselors; (2) evaluate the counselor-administered app’s sensitivity and specificity to detect NCI among 100 HIV+ adults, as well as its usability and acceptability; and (3) explore the association between NeuroScreen results and medical health outcomes – i.e., objective behavioral and biological markers of ART treatment failure. An mHealth tool like NeuroScreen could be easily modified for use in other diseases and LMICs that rely on task-shifting due to very limited healthcare resources.

Presentations/
Publications:

 

  • Robbins, R.N., Gouse, H. Jonah, V., Reneteria, M.A., Thomas, K.G., Remien, R.H., & Joska, J.A. (July, 2016). Adherence to Antiretroviral Therapy and Neurocognitive Impairment in South Africa. Poster presented at the 21st International AIDS Conference, Durban, South Africa. 

  • Robbins, R.N., Gouse, H. Jonah, V., Reneteria, M.A., Thomas, K.G., Remien, R.H., & Joska, J.A. (July, 2016). Evaluating a Tablet App for Lay Health Workers to Screen for HAND in South Africa. Poster presented at the 21st International AIDS Conference, Durban, South Africa. 

  • Robbins, R.N., Gouse, H. Jonah, V., Reneteria, M.A., Thomas, K.G., & Joska, J.A. (February, 2016). An Evaluation of the Construct Validity of a Neuropsychology Tablet App for Lay Health Workers to Screen for HAND in South Africa. Poster presented at the 44th International Neuropsychology Society Annual Meeting, Boston, MA.

  • Reneteria, M.A., Gouse, H., Jonah, V., Joska, J.A., & Robbins, R.N. Functional Assessment of HIV+ Adults in South Africa: Utility of the Patients’ Assessment of Own Functioning Questionnaire and Instrumental Activities of Daily Living Scale. (February, 2016). Poster presented at the 44th International Neuropsychology Society Annual Meeting, Boston, MA.