Nonverbal cognitive assessment of children in Tanzania with and without HIV

ABSTRACT

Children living with HIV can experience cognitive difficulties. Most neuropsychological tests have been constructed in Western languages, meaning they may not be appropriate for use in non-Western settings. To address this, we used an entirely nonverbal measure of cognitive ability in a sub-Saharan African sample. For this cross-sectional analysis, 316 children (162 HIV+ and 154 HIV-, ages 3–9) completed the Leiter-3 as part of a larger study in Dar es Salaam, Tanzania. Statistical tests included analysis of covariance and multiple linear regression to account for environmental variables. HIV+ children performed worse than HIV – controls on two composite scores: Nonverbal IQ (p < .001) and Processing Speed (p < 0.001). Similar trends were observed on core subtests. Multiple linear regression models revealed that age, socioeconomic status, and school attendance predicted all Leiter-3 test composites. Critically, the addition of HIV status to the models improved prediction of Nonverbal IQ (∆R² = 0.03, p = .001) and Processing Speed (∆R² = 0.06, p < .001). Children living with HIV performed worse than HIV- controls on most Leiter-3 measures. While age, SES, and school attendance predicted Leiter-3 performance, HIV status improved prediction capabilities when added to the model. The Leiter-3 may offer a viable measure of cognitive ability in non-Western settings that can be used in its original form without translation.

KEYWORDS:

• Nonverbal assessment
• HIV
• cognitive development
• socioeconomic status
• Africa

Acknowledgments

We would like to thank our Dar es Salaam-based Study Team Members: Joyce Machunda, Filmon Aloyce, Pascal Maibe, Godfrey Njau, Matilda Kabeho, Joyce Joseph, and Claudia Gasana.

We also thank Dr. Mecky Matee for his help with sustaining the research environment in Dar es Salaam. Finally, we thank Phoebe Cunningham who conducted the Principal Component Analysis on the demographics survey to create the SES composite score.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded by the National Institutes of Health (NIH), grant number 5R01HD095277 to principal investigator JCB.