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J Pediatr Infect Dis. 2018 Sep;13(3):185-201. doi: 10.1055/s-0038-1637020.

Validity of Neuropsychological Testing in Young African Children Affected by HIV.

Author information

Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA.
Family Clinical Research Unit, Tygerberg Hospital, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, RSA.
Wits Reproductive Health & HIV Institute (WRHI), Shandukani Clinic, Johannesburg, RSA.
Department of Psychiatry, Michigan State University, East Lansing, MI.
Harare Family Care CRS, University of Zimbabwe, College of Health Sciences Clinical Trials Unit, Harare, Zimbabwe.
University of North Carolina Project- Lilongwe, Malawi CRS, Malawi.
Makerere University-Johns Hopkins University Research Collaboration (MUJHU CARE LTD) CRS, Kampala, Uganda.
Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, South Africa.
Frontier Science Foundation, Amherst, NY.
Clinical Research Management, FHI360, Durham, NC.
Maternal Adolescent Pediatric Research Branch, DAIDS/NIAID/NIH, Rockville, MD.
Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI.
Department of Psychiatry, the University of Michigan, Ann Arbor, MI.



Western-constructed neuropsychological tests have been used in low and middle income countries to assess the impact of HIV/AIDS and other chronic illnesses. We explore using such instruments cross-culturally in a sub-Saharan Africa setting.


IMPAACT P1104S was a two-year observational study carried out at six clinical sites (South Africa- 3 sites, Malawi, Uganda and Zimbabwe) to assess and compare neuropsychological outcomes in three cohorts of children 5-11 years of age: HIV-infected (HIV), HIV-exposed but uninfected (HEU) and HIV unexposed and uninfected (HU). Descriptive statistics compared socio-demographic characteristics among children at sites. Instruments included the KABC-II cognitive ability, TOVA attention/impulsivity, BOT-2 motor proficiency tests, and BRIEF executive function problems. Test characteristics were assessed using intraclass and Spearman non-parametric correlations, linear regression and principal factor analyses.


Of the 611 participants, 50% were male and mean age ranged from 6.6 to 8 years. In Malawi, Uganda and Zimbabwe, substantial proportions of families lived in rural settings in contrast to the South African sites. Intraclass correlation coefficients between weeks 0 and 48 were highest for the KABC scores, ranging between 0.42 to 0.71.Correlations among similar test domains were low to moderate but significant, with positive correlation between KABC Sequential and TOVA scores and negative correlation between BRIEF and KABC scores. TOVA response time scores correlated negatively with the BOT-2 Total points score. Strong and significant associations between individual measures of growth, disability and development with all test scores were observed. Performance-based measures were markedly lower for HIV compared to HEU and HU participants, even after controlling for age, sex and site. Factor analyses confirmed the underlying theoretical structure of the KABC scaled item scores.


The KABC, TOVA, BRIEF and BOT-2 were valid and reliable tools for assessing the neuropsychological impact of HIV in four sub-Saharan African countries.


Africa; Neuropsychological testing; Pediatric HIV; reliability; validity

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