Tablet-Based Cognitive Impairment Screening for Adults With HIV Seeking Clinical Care: Observational Study

Area of Science:

• Neuroscience
• Public Health
• Medical Technology

Background:

• Neurological complications, including cognitive impairment, are prevalent in people with HIV (PWH) despite antiretroviral therapy.
• Routine cognitive screening is not standard practice in HIV clinics, potentially delaying diagnosis and intervention.

Purpose of the Study:

• To assess the feasibility of implementing an iPad-based cognitive impairment screener (BRACE) in adults receiving HIV care.
• To evaluate the psychometric properties, including reliability and validity, of the BRACE tool.
• To identify predictors of cognitive impairment using the BRACE screener.

Main Methods:

• A convenience sample of 404 adults with HIV completed the Brain Baseline Assessment of Cognition and Everyday Functioning (BRACE) on an iPad.
• BRACE includes tests of psychomotor speed, set-shifting, processing speed, and visual-spatial learning.
• Test-retest reliability and validity were assessed in subgroups; predictors were examined using electronic medical record data.

Main Results:

• BRACE was completed in a mean of 12 minutes. Cognitive impairment was identified in 17-44% of participants across individual tests, with 25% global impairment.
• Good test-retest reliability was observed (0.81 at 4 weeks, 0.63 at ~1 year), with no significant practice effects.
• BRACE demonstrated strong validity against a lengthier cognitive battery (r=0.63, 84% sensitivity, 94% specificity).

Conclusions:

• The iPad-based BRACE tool is feasible for implementation in routine HIV clinic settings.
• BRACE exhibits favorable psychometric properties, making it a reliable and valid instrument for cognitive screening.
• This tool can aid in addressing the ongoing concern of cognitive impairment among people with HIV.