Psychometric properties of International HIV Dementia Scale as screening tool for neurocognitive disorder among people living with HIV/AIDS

Individuals living with human immunodeficiency virus (HIV) frequently experience neurocognitive impairment. The most reliable approach for assessing cognitive function and diagnosing impairment is the administration of a comprehensive neuropsychological test battery. However, in low-resource settings, such assessments are often impractical as a first-line option. Consequently, screening tools such as the International HIV Dementia Scale (IHDS) and Mini-Mental State Examination (MMSE) are widely used for cognitive evaluation. Despite its widespread application, no studies have systematically evaluated the psychometric properties of the IHDS and MMSE in Ethiopian HIV/AIDS patients. Therefore, this study aims to assess the psychometric properties and reliability of the IHDS and MMSE in this population. A hospital-based cross-sectional study was conducted from February 10 to March 2, 2023, to evaluate cognitive function in Fifty-nine HIV-positive adults receiving antiretroviral therapy (ART), using the International HIV Dementia Scale (IHDS) and the Mini-Mental State Examination (MMSE). Cognitive impairment was determined using the Frascati criteria, which served as the diagnostic reference standard. The diagnostic accuracy and discriminatory power of the IHDS and MMSE were assessed using Receiver Operating Characteristic (ROC) curve analysis. Additional psychometric properties, including test-retest reliability, internal consistency, and content validity, were also evaluated. Multivariable linear regression analysis was performed to identify independent predictors of IHDS scores. A total of 59 HIV-positive participants were included in the study, of whom 57.7% were female and 42.3% male, with a mean age of 36.93 years (SD ± 13.08). The prevalence of HIV-associated neurocognitive disorder (HAND) was found to be 45.8% using the International HIV Dementia Scale (IHDS) and 39% using the Mini-Mental State Examination (MMSE). The optimal IHDS cutoff score of ≤ 10 yielded an area under the curve (AUC) of 0.81, with a sensitivity of 84.2% and specificity of 77.5%. For the MMSE, the optimal cutoff score was ≤ 27, with an AUC of 0.71, sensitivity of 83.9%, and specificity of 57.1%. Multivariable linear regression analysis indicated that being married (β = 0.6, p-value = 0.02) and being a young adult (β = 0.52, p-value = 0.04) were significantly associated with better neurocognitive performance. Both the International HIV Dementia Scale (IHDS) and the Mini-Mental State Examination (MMSE) proved useful for screening HIV-associated neurocognitive disorder (HAND) in Ethiopian HIV-positive adults, with the IHDS demonstrating superior diagnostic accuracy, including higher sensitivity and a greater area under the curve (AUC). The IHDS was shown to be a reliable, valid, low-cost, and rapid screening tool for HAND. This study established new local normative data and optimal cutoff values tailored for Amharic-speaking populations, supporting the integration of the IHDS into routine clinical practice in Ethiopia.