Game-based Cognitive Training for School-age Children Living With or Exposed to HIV: A Randomized Controlled Trial in...

Children with perinatally acquired HIV (PHIV) and those exposed to HIV but uninfected (HEU) are at increased risk for adverse cognitive and behavioral outcomes, particularly in sub-Saharan Africa. This study evaluated the efficacy of brain powered games (BPG), a mobile computerized cognitive rehabilitation intervention, on neurocognitive outcomes among children with PHIV, HEU, and HIV unexposed uninfected children (HUU) in Uganda and Malawi.

We conducted a randomized controlled trial in Uganda and Malawi enrolling 599 children aged 5 to 12 years (PHIV = 120, HEU = 239, HUU = 240). Participants were randomized to a 12-week BPG intervention or a waitlist. Neuropsychological outcomes were assessed at baseline, postintervention, and 6-month follow-up using the Kaufman Assessment Battery for Children Second Edition (KABC-II), test of variables of attention, and Cogstate. Linear mixed-effects models estimated intervention effects, separately by country.

In Uganda, children receiving BPG demonstrated higher Learning composite scores (3.34; 95% CI, 1.03-5.65), Mental Processing Index scores (2.39; 95% CI, 0.78-4.01), and Nonverbal Index scores in KABC-II (2.28; 95% CI, 0.27-4.28) immediately postintervention compared with waitlist. Cogstate Maze Learning was higher postintervention (0.02; 95% CI, 0.004-0.043) and at 6 months (0.02; 95% CI, 0.003-0.040). In Malawi, Planning scores (-2.22; 95% CI, -4.39 to -0.05) and Delayed Recall scores (-2.87; 95% CI, -5.22 to -0.51) in KABC-II were lower in the intervention arm postintervention, whereas Cogstate Identification scores were higher (-0.03; 95% CI, -0.05 to -0.004).

Mobile cognitive training produced modest, domain-specific cognitive benefits, with effects varying by context and HIV exposure status.