A Brief Neurocognitive Assessment for HAND in Low Resourced Occupational Health Settings in Developing Countries

Abstract

HIV associated neurocognitive disorder (HAND) is highly prevalent in sub-Saharan Africa, and with the support of anti-retroviral treatment, more people are able to remain in the workplace. However, the potential for HAND to affect the individual health and safety of employees is substantial. Formal assessment of HAND is resource intensive, and often outside the capability of smaller organisations which offers occupational health support. This paper describes a protocol for a brief neurocognitive assessment for HAND in low resourced occupational health settings. The paper firstly describes the development – following seven guidelines – of a relatively inexpensive and relatively brief protocol to assess for the presence of HAND, in a South African low resourced occupational health setting. The resultant Brief Neurocognitive Assessment (BNCA) is then described in detail, as well as the larger process within which it is administered. Further, neuropsychological data from the first 60 completed assessments are presented, together with a discussion of its adherence to the guidelines set out prior to its development. A number of neuropsychological markers appeared to differentiate between the normal and mild impairment groups, suggesting that the BNCA may be useful in identifying individuals with potential problematic neurocognitive functioning. A brief assessment such as the BNCA could provide meaningful recommendations regarding both clinical management and workplace utilisation to employers. It would be important that proper processes (e.g. conditions for assessments, appropriate follow up procedures, confidentiality, and so forth) are imposed and maintained. Finally, this paper invite discussion for improved management of HAND assessment in the workplace.