Lessons learned developing a diagnostic tool for HIV-associated dementia feasible to implement in resource-limited settings: pilot testing in Kenya
| Autor: | Craig R. Cohen, Elizabeth A. Bukusi, Judith K. Kwasa, Patrick Oyaro, Richard W. Price, Gretchen L. Birbeck, Dennis Osiemo, Ana-Claire Meyer, Edwin Lwanya, Deanna Cettomai |
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| Přispěvatelé: | Zheng, Jialin Charles |
| Rok vydání: | 2012 |
| Předmět: |
Gerontology
Adult Male medicine.medical_specialty AIDS Dementia Complex Epidemiology General Science & Technology Health Personnel education MEDLINE Alternative medicine Human immunodeficiency virus (HIV) lcsh:Medicine Pilot Projects Neuropsychological Tests medicine.disease_cause Global Health Clinical expertise Young Adult Clinical Research medicine Dementia Humans lcsh:Science Reliability (statistics) screening and diagnosis Multidisciplinary business.industry lcsh:R Middle Aged medicine.disease Kenya Detection Infectious Diseases Good Health and Well Being Neurology Family medicine Medicine HIV/AIDS Health Resources lcsh:Q Female Neuropsychological testing business Infection Limited resources Research Article 4.2 Evaluation of markers and technologies |
| Zdroj: | PloS one, vol 7, iss 3 PLoS ONE PLoS ONE, Vol 7, Iss 3, p e32898 (2012) |
| Popis: | Author(s): Kwasa, Judith; Cettomai, Deanna; Lwanya, Edwin; Osiemo, Dennis; Oyaro, Patrick; Birbeck, Gretchen L; Price, Richard W; Bukusi, Elizabeth A; Cohen, Craig R; Meyer, Ana-Claire L | Abstract: ObjectiveTo conduct a preliminary evaluation of the utility and reliability of a diagnostic tool for HIV-associated dementia (HAD) for use by primary health care workers (HCW) which would be feasible to implement in resource-limited settings.BackgroundIn resource-limited settings, HAD is an indication for anti-retroviral therapy regardless of CD4 T-cell count. Anti-retroviral therapy, the treatment for HAD, is now increasingly available in resource-limited settings. Nonetheless, HAD remains under-diagnosed likely because of limited clinical expertise and availability of diagnostic tests. Thus, a simple diagnostic tool which is practical to implement in resource-limited settings is an urgent need.MethodsA convenience sample of 30 HIV-infected outpatients was enrolled in Western Kenya. We assessed the sensitivity and specificity of a diagnostic tool for HAD as administered by a primary HCW. This was compared to an expert clinical assessment which included examination by a physician, neuropsychological testing, and in selected cases, brain imaging. Agreement between HCW and an expert examiner on certain tool components was measured using Kappa statistic.ResultsThe sample was 57% male, mean age was 38.6 years, mean CD4 T-cell count was 323 cells/µL, and 54% had less than a secondary school education. Six (20%) of the subjects were diagnosed with HAD by expert clinical assessment. The diagnostic tool was 63% sensitive and 67% specific for HAD. Agreement between HCW and expert examiners was poor for many individual items of the diagnostic tool (K = .03-.65). This diagnostic tool had moderate sensitivity and specificity for HAD. However, reliability was poor, suggesting that substantial training and formal evaluations of training adequacy will be critical to enable HCW to reliably administer a brief diagnostic tool for HAD. |
| Databáze: | OpenAIRE |
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