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The development of a screening tool to evaluate gross motor function in HIV-infected infants
Nicole Hilburn1, Joanne Potterton, Aimee Stewart
1Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa. nicole.hilburn@wits.ac.za
Insights
A new screening tool, the Infant Gross Motor Screening Test (IGMST), effectively identifies neurodevelopmental delay in infants with HIV. This tool aids in early intervention and treatment decisions for paediatric HIV/AIDS in developing countries.
Area of Science:
- Pediatric HIV/AIDS
- Neurodevelopmental Disorders
- Public Health
Background:
- Neurodevelopmental delay, or HIV encephalopathy, is a critical indicator of advanced pediatric HIV/AIDS (WHO Stage 4).
- Early initiation of highly active antiretroviral therapy (HAART) is crucial for preventing this condition.
- Developing countries often lack standardized neurodevelopmental assessment tools, relying instead on declining virologic and immunologic markers for HAART initiation.
Purpose of the Study:
- To develop and validate a standardized developmental screening tool for neurodevelopmental delay in infants in resource-limited settings.
- To provide an additional criterion for initiating HAART and facilitate referral to rehabilitation services.
Main Methods:
- The Infant Gross Motor Screening Test (IGMST) was developed using items from the Bayley Scales of Infant Development (BSID)-III Gross Motor scale.
- Standardization involved 112 HIV-infected infants (6-18 months).
- Content validity was assessed by expert consensus (Nominal Group Technique), concurrent validity against BSID-III (n=60), and reliability (inter-rater, test-retest, intra-rater) was evaluated.
Main Results:
- The IGMST demonstrated excellent concurrent validity with the BSID-III (Kappa = 0.85).
- Diagnostic properties were high: sensitivity 97.4%, specificity 85.7%, positive predictive value 92.7%, and negative predictive value 94.7%.
- Reliability testing showed excellent results (inter-rater r=1, test-retest r=0.98, intra-rater r=0.98).
Conclusions:
- The IGMST possesses excellent statistical properties, making it a suitable screening tool for neurodevelopmental delay in infants with HIV.
- This tool can significantly aid in early detection, intervention, and management of neurodevelopmental issues in pediatric HIV care, particularly in resource-limited settings.
Abstract:
Neurodevelopmental delay or HIV encephalopathy is a stage four disease indicator for paediatric HIV/AIDS according to the World Health Organisation (WHO), and may be used as a criterion for initiation of highly active antiretroviral therapy (HAART). To date, the only means of prevention of this condition is early initiation of HAART. Studies which have been carried out in South African clinics have revealed the high prevalence of this condition. In developing countries, commencement of HAART is based on declining virologic and immunologic status, as standardised neurodevelopmental assessment tools are not widely available. A standardised developmental screening tool which is suitable for use in a developing country is therefore necessary in order to screen for neurodevelopmental delay to allow for further assessment and referral to rehabilitation services, as well as providing an additional assessment criterion for initiation of HAART. The infant gross motor screening test (IGMST) was developed for this purpose. The standardisation sample of the IGMST consisted of 112 HIV-infected infants between six and 18 months of age. Item selection for the IGMST was based on the Gross Motor scale of the Bayley Scales of Infant Development (BSID)-III. Content validity was assessed by a panel of experts using a nominal group technique (NGT; agreement >80%). Concurrent validity (n=60) of the IGMST was carried out against the BSID-III, and agreement was excellent (K=0.85). The diagnostic properties of the IGMST were evaluated and revealed: sensitivity 97.4%, specificity 85.7%, positive predictive value (PPV) 92.7%, and negative predictive value (NPV) 94.7%. Reliability testing (n=30) revealed inter-rater reliability as: r=1, test-retest reliability: r=0.98 and intra-rater reliability: r=0.98. The results indicate that the statistical properties of the IGMST are excellent, and the tool is suitable for use within the paediatric HIV setting.
