Center for Microbiology Research Kenya Medical Research Institute, Nairobi, Kenya.
PLoS One. 2012;7(3):e32898. doi: 10.1371/journal.pone.0032898. Epub 2012 Mar 7.
To conduct a preliminary evaluation of the utility and reliability of a diagnostic tool for HIV-associated dementia (HAD) for use by primary health care workers (HCW) which would be feasible to implement in resource-limited settings.
In resource-limited settings, HAD is an indication for anti-retroviral therapy regardless of CD4 T-cell count. Anti-retroviral therapy, the treatment for HAD, is now increasingly available in resource-limited settings. Nonetheless, HAD remains under-diagnosed likely because of limited clinical expertise and availability of diagnostic tests. Thus, a simple diagnostic tool which is practical to implement in resource-limited settings is an urgent need.
A convenience sample of 30 HIV-infected outpatients was enrolled in Western Kenya. We assessed the sensitivity and specificity of a diagnostic tool for HAD as administered by a primary HCW. This was compared to an expert clinical assessment which included examination by a physician, neuropsychological testing, and in selected cases, brain imaging. Agreement between HCW and an expert examiner on certain tool components was measured using Kappa statistic.
The sample was 57% male, mean age was 38.6 years, mean CD4 T-cell count was 323 cells/µL, and 54% had less than a secondary school education. Six (20%) of the subjects were diagnosed with HAD by expert clinical assessment. The diagnostic tool was 63% sensitive and 67% specific for HAD. Agreement between HCW and expert examiners was poor for many individual items of the diagnostic tool (K = .03-.65). This diagnostic tool had moderate sensitivity and specificity for HAD. However, reliability was poor, suggesting that substantial training and formal evaluations of training adequacy will be critical to enable HCW to reliably administer a brief diagnostic tool for HAD.
初步评估一种适用于基层卫生保健工作者（HCW）且在资源有限环境中易于实施的用于诊断 HIV 相关痴呆（HAD）的诊断工具的实用性和可靠性。
在资源有限的环境中，无论 CD4 T 细胞计数如何，HAD 都是开始抗逆转录病毒治疗的指征。抗逆转录病毒治疗是 HAD 的治疗方法，现在在资源有限的环境中越来越普及。尽管如此，由于临床专业知识有限且缺乏诊断测试，HAD 的诊断仍然不足。因此，迫切需要一种简单的诊断工具，该工具在资源有限的环境中切实可行。
在肯尼亚西部，我们方便地招募了 30 名 HIV 感染门诊患者。我们评估了由基层 HCW 实施的 HAD 诊断工具的灵敏度和特异性。将其与专家临床评估进行比较，后者包括医生检查、神经心理测试，以及在某些情况下进行脑部成像。使用 Kappa 统计量来衡量 HCW 和专家检查者在某些工具组件上的一致性。
该样本中 57%为男性，平均年龄为 38.6 岁，平均 CD4 T 细胞计数为 323 个/µL，54%的人受教育程度低于中学。通过专家临床评估，有 6 名（20%）患者被诊断为 HAD。该诊断工具对 HAD 的灵敏度为 63%，特异性为 67%。HCW 和专家检查者之间对诊断工具的许多单个项目的一致性较差（K 值为.03-.65）。该诊断工具对 HAD 具有中等的灵敏度和特异性。然而，可靠性较差，这表明 HCW 要能够可靠地管理 HAD 的简短诊断工具，需要进行大量培训和正式评估培训的充分性。
