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Development and Validation of a Brief Digital Cognitive Screening Tool for HIV-associated Neurocognitive Disorder in
Abstract:
Background HIV-associated neurocognitive disorder (HAND) remains a frequent yet under-recognized complication among people with HIV (PWH), even while on antiretroviral therapy. In Peru, feasible and accurate brief cognitive tools are needed for underserved clinical settings. Methods We recruited Spanish-speaking adults with and without HIV in Lima, Peru. Eleven TabCAT tests were evaluated in a development sample, with demographic norms derived from adults without HIV. A four-test battery with an estimated administration time of 14 minutes was evaluated against a comprehensive paper-and-pencil reference battery in an additional sample of PWH. Concurrent validity was examined using correlations between cognitive tests in the same domain. Results Participants included 293 PWH (29.0% female; age [mean ± SD] 47.2 ± 11.8 years; education 12.8 ± 2.7 years) and 162 HIV-negative healthy adults (53.1% female; age 46.5 ± 14.2 years; education 13.6 ± 2.7 years). The four-test battery comprised Birdwatch, Match, Set Shifting, and Rapid Naming. Its area under the receiver operating characteristic curve (AUC) was 0.797 (95% CI: 0.691, 0.903; n = 115) in development and 0.819 (95% CI: 0.740, 0.899; n = 150) in validation samples. Validation sensitivity was 81.6% and specificity was 70.5%. Digital tests exhibited domain-specific moderate correlations with reference paper-and-pencil tests demonstrating concurrent validity. Conclusions This brief battery shows promise for cognitive screening among literate, Spanish-speaking PWH in urban Peru. However, it does not establish a clinical HAND diagnosis. Further evaluation of interpretation thresholds, lower literacy levels and rural populations, and referral pathways is needed before routine implementation of this tool.