P3C111: Development of a Neurophysiology Lab in Western Kenya to Advance the Science of Neurocognitive Physiology in Individuals Living with HIV

Background: Over 1.7 million adolescents live with HIV worldwide, with nearly 90% residing in sub-Saharan Africa. Evidence suggests adolescents living with HIV (ALHIV) have worse cognitive outcomes, but little is known about the neurophysiology underlying these differences. Most methods for examining neurophysiology require vast infrastructure and resources to implement successfully. Brain event-related potentials (ERPs), measured by quantitative electroencephalography (EEG), reflect the neural building blocks of complex cognitive processes and is a relatively resource-efficient method for evaluating neurophysiology. However, most ERP studies are performed in high resourced settings. Here, we describe the development of a neurophysiology lab in western Kenya, with the goal of expanding evidence-based HIV research infrastructure within the most affected settings.

Project Description: With funding from Indiana University and the National Institute of Health (NIH), as well as infrastructure support from Moi University, the first-of-its-kind neurophysiology lab was completed in 2022 specifically for HIV research. This lab is housed in Moi University’s Medical Education Center within the Academic Model Providing Access to Healthcare (AMPATH), a 30-year collaboration among Kenyan and U.S. institutions, based in Eldoret, Kenya. The lab contains an EEG, equipment for ERP paradigms (auditory steady state response; P50 sensory gating; mismatch negativity; P300 auditory oddball task; error-related negativity), and neuromotor tasks (postural sway; delayed eye blinking conditioning). Research personnel are trained to administer these measures, and extensive training for students and technicians throughout Kenya is ongoing.

Discussion: To our knowledge, this is the first neurophysiology research lab within a public academic center in East Africa. Critical lessons learned while building neurophysiology research infrastructure in a low-resource setting include: overcoming barriers using highly sensitive equipment within a setting of substantial environmental noise and electrical interference; ensuring secure and accurate data storage for complex files from precisely synchronized programs, and establishing standard operating procedures for lab continuity. This new research infrastructure has great potential to provide equity in HIV research, allowing for questions about neurophysiology and cognition to be generated and explored by populations most impacted by HIV.

Conclusion: The formation of this lab and training initiatives have potential to make meaningful progress towards improving neurocognitive outcomes across East Africa and beyond. A pilot study is underway to determine the impact of HIV on the adolescent brain. Additional grants are submitted to evaluate outcomes across the lifespans of adolescents living with HIV in low-resource settings.