JMIR Publications

ABSTRACT

Background:

Adolescents living with perinatally acquired HIV (PHIV) remain at risk for neurocognitive difficulties, yet access to valid neurocognitive tests is limited in sub-Saharan Africa (SSA), where most of this population resides. Neurocognitive tests that can be administered by non-expert personnel, are culturally and linguistically appropriate for the diverse populations of SSA and are brief enough for routine use are needed to expand access to assessment, but few such tools exist.

Objective:

We adapted NeuroScreen, a brief tablet-based neurocognitive test battery, into Luganda and evaluated its validity and acceptability for use with Ugandan adolescents with PHIV.

Methods:

One hundred Ugandan adolescents aged 11 to 20 years (50 with PHIV; 50 HIV-negative controls) completed the Luganda- or English-language NeuroScreen battery and a commonly used paper-and-pencil test battery. We examined convergent validity using correlations between overall and individual test performance, known-groups validity by comparing PHIV and control performance, criterion validity by comparing impairment classifications derived from global z-scores, and acceptability through self-reported technology use and ease of use.

Results:

NeuroScreen and traditional battery global z-scores were strongly correlated (r = 0.75, p <0.01). Tests assessing similar domains showed generally small-to-moderate correlations (r’s=0.22 – 0.47), with the strongest correspondence for processing speed, attention, and working memory. Adolescents with PHIV performed significantly worse than controls on global scores for both NeuroScreen and the traditional battery, and this pattern was most consistent for processing speed and executive functioning tests. Impairment classifications showed modest agreement across batteries, with both identifying more PHIV participants than controls as impaired. Although fewer than half of participants had previously used a tablet, NeuroScreen was rated as easy to use.

Conclusions:

The Luganda-adapted NeuroScreen demonstrated acceptable convergent, known-groups, and criterion validity in Ugandan adolescents with PHIV. By delivering automated administration, automated scoring, and standardized multimedia instructions in the local language on a low-cost, portable tablet, NeuroScreen addresses several persistent barriers to neurocognitive assessment in low-resource settings, including shortages of specialist personnel, the time burden of traditional batteries, and the scarcity of culturally and linguistically appropriate tools. Its brevity (approximately 25 minutes) and high acceptability among adolescents with little or no prior tablet experience suggest that the app could be administered by non-specialist staff and integrated into routine HIV care in sub-Saharan Africa. These findings add to a growing body of evidence supporting tablet-based assessment as a practical and scalable mobile health approach to expanding access to neurocognitive testing. Future research should evaluate test-retest reliability, sensitivity to change over time, normative benchmarks, and implementation within real-world clinical workflows.