A Brief Neurocognitive Assessment for HAND in Low Resourced Occupational Health Settings in Developing Countries
HIV associated neurocognitive disorder (HAND) is highly prevalent in sub-Saharan Africa, and with the support of anti-retroviral treatment, more people are able to remain in the workplace. However, the potential for HAND to affect the individual health and safety of employees is substantial. Formal assessment of HAND is resource intensive, and often outside the capability of smaller organisations which offers occupational health support. This paper describes a protocol for a brief neurocognitive assessment for HAND in low resourced occupational health settings. The paper firstly describes the development – following seven guidelines – of a relatively inexpensive and relatively brief protocol to assess for the presence of HAND, in a South African low resourced occupational health setting. The resultant Brief Neurocognitive Assessment (BNCA) is then described in detail, as well as the larger process within which it is administered. Further, neuropsychological data from the first 60 completed assessments are presented, together with a discussion of its adherence to the guidelines set out prior to its development. A number of neuropsychological markers appeared to differentiate between the normal and mild impairment groups, suggesting that the BNCA may be useful in identifying individuals with potential problematic neurocognitive functioning. A brief assessment such as the BNCA could provide meaningful recommendations regarding both clinical management and workplace utilisation to employers. It would be important that proper processes (e.g. conditions for assessments, appropriate follow up procedures, confidentiality, and so forth) are imposed and maintained. Finally, this paper invite discussion for improved management of HAND assessment in the workplace.
Charles Van Wijk,
A Brief Neurocognitive Assessment for HAND in Low Resourced Occupational Health Settings in Developing Countries, Central African Journal of Public Health.
Vol. 5, No. 1,
2019, pp. 24-30.
Antinori A, Arendt G, Becker JT, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurol 2007; 69(18):1789-1799.
Chan P, Brew BJ. HIV associated neurocognitive disorders in the modern antiviral treatment era: prevalence, characteristics, biomarkers, and effects of treatment. Curr HIV/AIDS Rep 2014; 11(3):317–24.
Grant I. Neurocognitive disturbances in HIV. Int Rev Psychiatry 2008; 20:33-47.
Grant I, Sacktor N, McArthur JC. HIV and neurocognitive disorders. In Gendelman HE, Grant I, Everall I, Lipton SA, Swindells S, eds. The Neurology of AIDS. 2 nd Edition. Oxford: Oxford University Press; 2005: 359-374.
Heaton RK, Clifford DB, Franklin DR, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurol 2010; 75(23):2087–96.
Robertson KR, Smurzynski M, Parsons TD, et al. The prevalence and incidence of neurocognitive impairment in the HAART era. AIDS 2007; 21:1915-1921.
Schouten J, Cinque P, Gisslen M, Reiss P, Portegies P. HIV-1 infection and cognitive impairment in the cART era: a review. AIDS 2011; 25:561-575.
Simioni S, Cavassini M, Annoni JM, et al. Cognitive dysfunction in HIV patients despite long-standing suppression of viremia. AIDS 2010; 24:1243–1250.
Joska JA, Westgarth-Taylor J, Myer L, et al. Characterization of HIV-associated neurocognitive disorders among individuals starting antiretroviral therapy in South Africa. AIDS Behav 2011; 15(6):1197-1203.
Van Wijk CH, Meintjes WAJ. International HIV Dementia Scale: Screening for HIV associated neurocognitive disorders in occupational Settings. Occup Health Southern Afr 2015; 21(4):10-16.
Dawes S, Suarez P, Casey CY, et al. Variable patterns of neuropsychological performance in HIV-1 infection. J Clin Exp Neuropsychol 2008; 30: 613–626.
Cherner M, Cysique L, Heaton RK, et al. Neuropathologic confirmation of definitional criteria for human immunodeficiency virus-associated neurocognitive disorders. J Neurovirol 2007; 13:23-28.
Robertson K, Liner J, Heaton R. Neuropsychological assessment if HIV infected populations in international settings. Neuropsychol Rev 2009; 19:232-249.
Woods SP, Moore DJ, Weber E, Grant I. Cognitive Neuropsychology of HIV-Associated Neurocognitive Disorders. Neuropsychol Rev 2009; 19:152–168.
Gorman AA, Foley JM, Ettenhofer ML, Hinkin CH, van Gorp WG. Functional consequences of HIV-associated neuropsychological impairment. Neuropsychol Rev 2009; 19:186-203.
Bor J, Tanser F, Newell M-L, Bärnighausen T. In a study of a population cohort in South Africa, HIV patients on antiretrovirals had nearly full recovery of employment. Health Aff 2012; 31(7):1459-1469.
Marcotte TD, Wolfson T, Rosenthal TJ, et al. A multimodal assessment of driving performance in HIV infection. Neurol 2004; 63:1417-1422.
Mind Exchange Working Group. Assessment, Diagnosis, and Treatment of HIV-Associated Neurocognitive Disorder: A Consensus Report of the Mind Exchange Program. Clin Infect Dis 2013; 56:1004-1017.
Watts AD, Shuttleworth-Edwards AB. Neuropsychology in South Africa: confronting the challenges of specialist practice in a culturally diverse developing country. Clin Neuropsychol 2016; 30(8):1305-1324.
Thom RGM. HAART and Mind: Common Mental Disorders in People Living with HIV/AIDS. The Access Series. South Africa: Reach Publishers, 2012.
Jonsson G, Davies N, Freeman C, et al. Management of mental health disorders in HIV-positive patients. S Afr J HIV Med 2013; 14(4):155-165.
Haddow LJ, Floyd S, Copas A, Gilson RJC. A Systematic Review of the Screening Accuracy of the HIV Dementia Scale and International HIV Dementia Scale. PLoS ONE 2013; 8(4):e61826.
Singh D, Sunpath H, John S, Eastham L, Gouden R. The utility of a rapid screening tool for depression and HIV dementia amongst patients with low CD4 counts - a preliminary report. Afr J Psychiatry 2008; 11:282-286.
Singh D, Joska JA, Goodkin K, et al. Normative scores for a brief neuropsychological battery for the detection of HIV-associated neurocognitive disorder (HAND) among South Africans. BMC Res Notes 2010; 3:28.
Joska JA, Westgarth-Taylor J, Hoare J, et al. Validity of the International HIV Dementia Scale in South Africa. AIDS Patient Care STDS 2011; 25:95-101.
Stern Y, McDermott MP, Albert S, et al. Factors associated with incident Human Immunodeficiency Virus dementia. Arch Neurol 2001; 58:473-479.
Carey CL, Woods SP, Rippeth JD, et al. Initial validation of a screening battery for the detection of HIV-associated cognitive impairment. Clin Neuropsychol 2004; 18:234–248
Sacktor NC, Wong M, Nakasujja N, et al. The International HIV Dementia Scale: a new rapid screening test for HIV dementia. AIDS 2005; 19:1367-1374.
Yepthomi T, Paul R, Vallabhaneni S, et al. Neurocognitive consequences of HIV in southern India: A preliminary study of clade C virus. J Int Neuropsychol Soc 2006; 12:424–430.
Maj M, D'Elia L, Satz P, et al. Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: a WHO study. Arch Clin Neuropsychol 1993; 8:123-135.
Lawler K, Mosepele M, Ratcliffe S, et al. Neurocognitive impairment among HIV positive individuals in Botswana: a pilot study. J Int AIDS Soc 2010; 13:15.
Ferrett HL, Thomas KGF, Tapert SF, et al. The Cross-cultural Utility of Foreign- and Locally-derived Normative Data for Three WHO-endorsed Neuropsychological Tests for South African Adolescents. Metab Brain Dis 2014; 29(2):395–408.
Army Individual Test Battery. Manual of directions and scoring. Washington, DC: War Department. Adjutant Generals Office, 1944.
Andrews K, Shuttleworth-Edwards AB, Radloff SE. Normative indications for Xhosa speaking unskilled workers on the Trail Making and Stroop Tests. J Psychol Afr 2012; 22(3):333-342.
Ruff RM, Parker SB. Gender and age-specific changes in motor speed and eye-hand coordination in adults: Normative values for the Finger Tapping and Grooved Pegboard Test. Percep Mot Skills 1993; 76:1219-1230.
Van Wijk CH, Meintjes WAJ. Grooved pegboard for adult employed South Africans: Normative data and HIV associations. S Afr J Psychol 2015; 45(4):521-535.
Holguin A, Banda M, Willen EJ, et al. HIV-1 Effects on Neuropsychological Performance in a Resource-Limited Country, Zambia. AIDS Behav 2011; 15:1895-1901.
Wechsler D. Wechsler Adult Intelligence Scale. 3rd Edition. New York: The Psychological Corporation; 1997.
Price RW, Sidtis JJ. Evaluation of the AIDS dementia complex in clinical trials. J AIDS 1993; 3(Suppl 2):551–560.
Robertson KR, Parsons TD, Sidtis JJ, et al. Timed Gait Test: Normative data for the assessment of the AIDS Dementia Complex. J Clin Exp Neuropsychol 2006; 28:1053-1064.
Sacktor N, Nakasujja N, Roberson K, Clifford DB. HIV-associated cognitive impairment in sub-Saharan Africa – the potential effect of clade diversity. Nat Clin Pract Neurol 2007; 3(8):436-443.
Joska JA, Fincham DS, Stein DJ, Paul RH, Seedat S. Clinical correlates of HIV-associated neurocognitive disorders in South Africa. AIDS Behav 2010; 14(2):371-378.