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Am. J. Trop. Med. Hyg., 80(6), 2009, pp. 1054-1059
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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SHORT REPORT


Closing Gaps in Antiretroviral Therapy Access: Human Immunodeficiency Virus–Associated Dementia Screening Instruments for Non-Physician Healthcare Workers

Michelle P. Kvalsund, Alan Haworth, Daniel L. Murman, Ellen Velie, AND Gretchen L. Birbeck*
International Neurologic and Psychiatric Epidemiology Program, and College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Department of Psychiatry, University of Zambia, Lusaka, Zambia; Department of Neurological Sciences, University of Nebraska, Omaha, Nebraska; Chikankata Health Services, Mazabuka, Zambia

 

ABSTRACT

Human immunodeficiency virus–associated dementia (HIV-D) is an indication for antiretroviral therapy (ART), but HIV-D is not routinely screened for in ART clinics in sub-Saharan Africa. Given the dearth of physicians in sub-Saharan Africa, enabling non-physician healthcare workers to identify HIV-D is crucial for early treatment initiation and preventing chronic neurologic disability. Non-physician healthcare workers administered locally adapted screening instruments to 48 persons living with acquired immunodeficiency syndrome (PLWAs), and 15 healthy comparison persons provided normative data. Stage IV PLWAs performed worse than the comparison group on all tests. Overall, 24 (50%) of 48 PLWAs had significant cognitive impairment. Among HIV staging categories, 1 stage II (33%), 6 stage III (42%), and 17 stage IV (55%) patients were identified as cognitively impaired. Our pilot study indicates that screening instruments used by non-physician healthcare workers can identify cognitive impairment in PLWAs and may facilitate appropriate initiation of ART in resource-poor settings.

Received April 4, 2008. Accepted for publication February 19, 2009.

Acknowledgments: We thank the administrators at Our Lady’s Hospice for the support and expertise that made this project possible; the healthcare workers at Our Lady’s Hospice in Kalingalinga for assistance with interviewing despite their busy schedules; the translators from Chainama College of Health Sciences for the many long hours spent diligently translating study documents; and, most especially, the patients, families, and community members who participated in the study.

Financial support: This study was supported by a U.S. Student Fulbright Grant and Sigma Delta Epsilon Women in Science Hartley Fellowship.

* Address correspondence to Gretchen L. Birbeck, International Neurologic and Psychiatric Epidemiology Program, Michigan State University, 324 W Fee Hall, East Lansing, MI 48824. E-mail: gretchen.birbeck{at}ht.msu.edu

Note: An appendix (Zambian Mini-Mental State Examination) appears online at www.ajtmh.org.

Authors’ addresses: Michelle P. Kvalsund and Gretchen L. Birbeck, International Neurologic and Psychiatric Epidemiology Program, Michigan State University, 324 W Fee Hall, East Lansing, MI 48824, E-mails: michelle.kvalsund{at}ht.msu.edu and Gretchen.birbeck{at}ht.msu.edu. Alan Haworth, University of Zambia, PO Box 33991, Lusaka, Zambia, E-mail: alan.haworth{at}yahoo.com. Daniel L. Murman, Department of Neurological Sciences, University of Nebraska, 982045 Nebraska Medical Center, Omaha, NE 68198, E-mail: dlmurman{at}unmc.edu. Ellen Velie, Department of Epidemiology, Michigan State University, B627 West Fee Hall, East Lansing, MI 48824, E-mail: velie{at}epi.msu.edu.






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Copyright © 2009 by the American Society of Tropical Medicine and Hygiene.