Psychometric evaluation of the computerized battery for neuropsychological evaluation of children (BENCI) among school aged children in the context of HIV in an urban Kenyan setting

Introduction
Culturally validated neurocognitive measures for children in Low- and Middle-Income Countries are important in the timely and correct identifcation of neurocognitive impairments. Such measures can inform development of interventions for children exposed to additional vulnerabilities like HIV infection. The Battery for Neuropsychological Evaluation of Children (BENCI) is an openly available, computerized neuropsychological battery specifcally developed to evaluate neurocognitive impairment. This study adapted the BENCI and evaluated its reliability and validity in Kenya.

Methodology
The BENCI was adapted using translation and back-translation from Spanish to English. The psy‑
chometric properties were evaluated in a case–control study of 328 children (aged 6 – 14 years) living with HIV and 260 children not living with HIV in Kenya. We assessed reliability, factor structure, and measurement invariance with
respect to HIV. Additionally, we examined convergent validity of the BENCI using tests from the Kilif Toolkit.

Results
Internal consistencies (0.49<α<0.97) and test–retest reliabilities (-.34 to .81) were sufcient-to-good for most of the subtests. Convergent validity was supported by signifcant correlations between the BENCI’s Verbal memory
and Kilif’s Verbal List Learning (r=.41), the BENCI’s Visual memory and Kilif’s Verbal List Learning (r=.32) and the BENCI’s Planning total time test and Kilif’s Tower Test (r= -.21) and the BENCI’s Abstract Reasoning test and Kilif’s Raven’s
Progressive Matrix (r=.21). The BENCI subtests highlighted meaningful diferences between children living with HIV and those not living with HIV. After some minor adaptions, a confrmatory four-factor model consisting of fexibility,
fuency, reasoning and working memory ftted well (χ2=135.57, DF=51, N=604, p<.001, RMSEA=.052, CFI=.944, TLI=.914) and was partially scalar invariant between HIV positive and negative groups.

Conclusion
The English version of the BENCI formally translated for use in Kenya can be further adapted and inte‑
grated in clinical and research settings as a valid and reliable cognitive test battery.