Multiple studies have demonstrated the validity of the NIH Toolbox – Cognitive Battery (NIHTB-CB) to measure cognitive function of children and adults in the United States. However, it has not been validated for use in non-Western populations. The use of the NIHTB-CB is an attractive option for low-resource settings because of its portability and ease of administration.

Children with and without HIV-infection completed a traditional paper-and-pencil neuropsychological battery and a customized battery from the NIHTB. Face validity was examined using qualitative methods to ascertain subjects’ recognition of cognitive concepts of interests (e.g., attention, memory), and comprehension of NIHTB-CB task instructions. Construct validity was examined using correlations between the NIHTB-CB and traditional NP tests; and using correlations with and parents’ ratings of their child’s intellectual ability and school performance. Receiver Operating Characteristic (ROC) curves were developed to identify cutoffs to define impairment. 

A total of 389 children (n=206 with HIV infection (HIV); n=183 HIV-exposed, uninfected (HEU)), 8-17 years of age were evaluated.  Most subjects were able to understand and complete all assessments.  There was moderate convergence between the NIHTB-CB and traditional neuropsychological measures, and the NIHTB-CB composite score discriminated between HIV and HEU groups. The NIHTB-CB composite score was positively associated with external criteria for cognitive function, correlating with parental ratings of intelligence (r=.26, p < .001) and school performance (r=.40, p <.001). However, children encountered some challenges in completing assessments due to vocabulary and cultural differences.