Acceptability of a Computerized Neurocognitive Battery to Identify Cognitive Impairments Among Children and Adolescents in Botswana

Human immunodeficiency virus (HIV) infection and in utero exposure increase the risk of neurocognitive deficits, but comprehensive neurocognitive screening is unavailable in settings with high HIV prevalence (e.g., Sub-Saharan Africa). The Penn Computerized Neurocognitive Battery (PennCNB) was culturally adapted and translated for use among children and adolescents in Botswana. To prepare for the implementation process, this study assessed perceptions of acceptability, a leading indicator of implementation success, of the adapted PennCNB among a cohort of HIV+ and HIV-exposed-uninfected (HEU) young people (N = 155, aged 7–17 years) in Gaborone, Botswana. Immediately following completion of the PennCNB, participants completed a three-point Likert scale survey eliciting perspectives of acceptability of the overall PennCNB and the 13 individual subtests and provided open-ended responses to elaborate upon acceptability ratings. Descriptive statistics were calculated, and predictors (age, sex, and PennCNB performance) of unacceptable response were evaluated using logistic regressions. A content analysis was completed on the open-ended responses. Participants reported high acceptability of the overall PennCNB (98%). Of the subtests, the Penn Trailmaking Test, Part A (measuring sensorimotor/processing speed) received the highest acceptability rating (82%), while the Penn Face Memory test (measuring episodic memory) was the least acceptable (40% unacceptable). Age and performance on the PennCNB were associated with an unacceptable response for Fractal N-Back (OR 0.873) and the Penn Line Orientation Test (OR 0.620), respectively. Themes about the content of the cognitive assessment, features of the tests, and participant characteristics were articulated as reasons for reporting the PennCNB subtests as acceptable or unacceptable. Overall, this research offers promise for successful implementation of the PennCNB for use among pediatric populations in Botswana.