Adverse Childhood Experiences And Neurocognitive Outcomes Of Adolescents With Perinatal HIV (PHIV) In Uganda

Abstract

Background: Adverse childhood experiences (ACEs; e.g., physical, sexual, emotional abuse) are associated with poor neurocognitive outcomes in adults with HIV, including those on long-term antiretroviral treatment (ART). These associations suggest early psychosocial experiences may impact neurocognitive outcomes in adults with HIV. Less is known about the direct influence of ACEs on neurocognitive outcomes among adolescents with HIV, particularly in a low resource setting like Uganda, where HIV and ACEs are both prevalent. This study examined associations between ACEs and neurocognitive outcomes among Ugandan adolescents and young adults with perinatal HIV (PHIV). Methods: 95 adolescents were recruited from Kampala, Uganda. Measures of ACEs and NeuroScreen, a tablet-based neurocognitive assessment battery were administered. The ACE Scale is a 17 item (Yes/No) scale measuring experiences of adversity. Total scores were produced by summing affirmative responses to adversity categories. The NeuroScreen is a highly automated, easy-to-use, tablet-based screening test to detect neurocognitive impairment (NCI) and has subtests assessing executive functioning, speed of processing, freedom from distractibility, and attention. The analysis was grouped by zero ACEs and by those that were 1 and higher. Results: Majority were male (51.6%), PHIV (51.6%), mean age of 15.6 years. PHIV group reported more ACEs p (0.023). There was a higher likelihood of PHIV and being threatened or actually thrown out of the house or being abandoned by a parent or guardian p(0.016). PHIV group had a lower NeuroScreen global Z score p(0.05) compared to the control group specifically on the trail-making p(0.035), working memory p(0.039), Visual discrimination p(0.017) and verbal learning p(0.029) scales. Number speed was significant (0.04) between the PHIV, ACE groups. Conclusion: ACEs are prevalent among Ugandan adolescents and young adults and may affect performance on select scales of neurocognitive test batteries. Perinatal HIV infection may predict low performance on the trails making and the visual discrimination tests of the Neuroscreen, which are tests for thinking, memory, and reasoning, while ACEs in PHIV may predict low scores on the number speed subscale. Further research is needed to ascertain the extent to which ACEs affect Cognition and its improvement among PHIV.