Introduction: Human Immunodeficiency Virus (HIV) infection and in utero HIV exposure are associated with increased risk of pediatric neurocognitive impairment. In Sub-Saharan Africa, in utero HIV exposures and infection are common, but standardized cognitive screening is limited. To address the lack of available neurocognitive screening, the Penn Computerized Neurocognitive Battery (PennCNB), a tool that streamlines evaluation of neurocognitive functioning, was culturally adapted for use among youth in Botswana. The current sub-study examined the structural validity of the culturally-adapted PennCNB.

Methodology: A cohort of 7-17 year old children living with HIV (HIV+) and HIV-exposed-uninfected (HEU) children were enrolled from the Botswana-Baylor Children’s Clinical Centre of Excellence in Gaborone, Botswana. Confirmatory and exploratory factor analyses were performed on speed, accuracy, and efficiency measures for 13 PennCNB tests.

Results: Fit of the confirmatory factor analysis was acceptable, which supports the design of the battery measuring four neurocognitive domains: executive functioning, episodic memory, complex cognition, and sensorimotor/processing speed. The model revealed high inter-factor correlation. Exploratory factor analysis suggested that tests assessing executive functioning and sensorimotor/processing speed clustered together rather than forming distinct factors, which is consistent for this age group.

Conclusions: These findings provide valuable insight into the structural validity of a computerized neurocognitive battery adapted for use in Botswana, suggesting that the PennCNB could serve as a useful tool for the assessment of neurocognitive function in a non-Western setting such as Sub-Saharan Africa, thus providing advantages for implementation, such as automated scoring and data generation, increased standardization and reliability, and ease of administration.