A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa

J. A. Joska, J. Witten, K. G. Thomas, C. Robertson, M. Casson-Crook, H. Roosa, J. Creighton, J. Lyons, J. McArthur, N. C. Sacktor

Research output: Contribution to journalArticle

Abstract

Screening for HIV-associated neurocognitive disorders (HAND) is important to improve clinical outcomes. We compared the diagnostic sensitivity and specificity of the mini-mental state examination, International HIV dementia scale (IHDS), Montreal cognitive assessment, Simioni symptom questionnaire and cognitive assessment tool-rapid version (CAT-rapid) to a gold standard neuropsychological battery. Antiretroviral-experienced participants from Cape Town, South Africa, and Baltimore, USA, were recruited. The sensitivity and specificity of the five tools, as well as those of the combined IHDS and CAT-rapid, were established using 2 × 2 contingency tables and ROC analysis. More than a third (65165) had symptomatic HAND. In detecting HIV-D, the CAT-Rapid had good sensitivity (94 %) and weak specificity (52 %) (cut-point ≤10), while the IHDS showed fair sensitivity (68 %) and good specificity (86 %) (cut-point ≤10). The combined IHDS and CAT-rapid showed excellent sensitivity and specificity for HIV-D at a cut-off score of ≤16 (out of 20; 89 and 82 %). No tool was adequate in screening for any HAND. The combination IHDS and CAT-rapid tool appears to be a good screener for HIV-D but is only fairly sensitive and poorly specific in screening for any HAND. Screening for milder forms of HAND continues to be a clinical challenge.

Original languageEnglish (US)
Pages (from-to)1621-1631
Number of pages11
JournalAIDS and behavior
Volume20
Issue number8
DOIs
StatePublished - Aug 1 2016

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Keywords

  • HIV-associated neurocognitive disorders
  • HIV-dementia
  • Screening

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Joska, J. A., Witten, J., Thomas, K. G., Robertson, C., Casson-Crook, M., Roosa, H., Creighton, J., Lyons, J., McArthur, J., & Sacktor, N. C. (2016). A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa. AIDS and behavior, 20(8), 1621-1631. https://doi.org/10.1007/s10461-016-1316-y