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Eaton AD, Chan Carusone S, Murzin K, Hui J, McCullagh JW, Walmsley SL. Cognitive screening considerations for psychosocial clinical trials in HIV, aging, and cognition. Clin Trials 2023; 20:176-180. [PMID: 36924070 DOI: 10.1177/17407745221136970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Cognitive impairment is a common comorbidity among individuals aging with HIV, which can be an extreme source of stress and anxiety for many. Psychosocial interventions have the potential to alleviate symptoms associated with cognitive impairment and help improve the quality of life of people with HIV as they continue to age; these interventions are in the infancy of development and require further testing via clinical trials. The slow development of interventions may be partially attributed to a common trend of requiring a formal HIV-associated neurocognitive disorder diagnosis to qualify for psychosocial clinical trials. HIV-associated neurocognitive disorder is diagnosed through intensive, time-consuming tests, and still many cases of HIV-associated neurocognitive disorder remain undiagnosed, misdiagnosed, or misclassified due to the limitations of the assessment process. This commentary suggests an alternate method of screening for cognitive impairments through the use of a brief, low-barrier assessment, alongside validity considerations. Such alternate screening may improve enrollment and completion rates in psychosocial clinical trials for people aging with HIV and cognitive impairment, by removing the burden of extensive testing that is commonly associated with an HIV-associated neurocognitive disorder diagnosis from clinical trial eligibility, while still providing valuable insight into individuals' cognitive functioning.
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Affiliation(s)
- Andrew D Eaton
- Faculty of Social Work-Saskatoon Campus, University of Regina, Saskatoon, SK, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Soo Chan Carusone
- Casey House, Toronto, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Jenny Hui
- Faculty of Social Work-Saskatoon Campus, University of Regina, Saskatoon, SK, Canada.,Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | | | - Sharon L Walmsley
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
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Li Y, Xiao X, Zhou Y, Su X, Wang H. The mediating role of executive function in the relationship between self-stigma and self-injury or suicidal ideation among men who have sex with men living with HIV. Front Public Health 2023; 10:1066781. [PMID: 36699888 PMCID: PMC9869120 DOI: 10.3389/fpubh.2022.1066781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Men who have sex with men (MSM) living with HIV suffer from psychosocial pressures and marginalization as a result of being HIV-positive and belonging to a sexual minority group, and self-injury or suicidal ideation are prevalent among this group. Studies have found that both perceived self-stigma and altered executive function is related to self-injury or suicidal ideation. However, the combined contribution of self-stigma and executive function to self-injury or suicidal ideation remains unclear, especially in MSM living with HIV. Therefore, this study is conducted to explore the mechanism of self-injury or suicidal ideation by hypothesizing that executive function plays a mediating role in the relationship between self-stigma and self-injury or suicidal ideation. Methods We conducted a cross-sectional survey among 448 MSM living with HIV who were recruited in the HIV clinic of a tertiary general hospital in Changsha, China, from November 2021 to February 2022. A questionnaires survey was adopted to collect sociodemographic and disease-related information and data related to executive function (including working memory, inhibition, and task monitoring), self-stigma, and self-injury or suicidal ideation. Structural equation modeling and bootstrap testing were used to investigate the potential mediating role of executive function in the relationship between self-stigma and suicidal ideation. Results The participants were aged 18-76 years. Those who had ever had self-injury or suicidal ideation accounted for 32.8% of the total. A higher level of self-stigma and poorer executive function were associated with more frequent self-injury or suicidal ideation (p < 0.01). The mediation model analysis showed a good fit (x 2/df = 1.07, p = 0.381). The direct effect of self-stigma on self-injury or suicidal ideation (β = 0.346, p < 0.001) and the indirect effect of self-stigma via executive function (β = 0.132, p < 0.001) were significant, with the indirect effect accounting for 27.6% of the total effect. Conclusions This study demonstrates that executive function mediates the relationship between self-stigma and self-injury or suicidal ideation among MSM living with HIV. It suggests that future studies targeting enhancing executive function and decreasing self-stigma may reduce self-injury or suicidal ideation among MSM living with HIV.
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Munsami A, Nightingale S, Sorsdahl K, Joska JA. Exploring HIV-Associated Neurocognitive Impairment in the Era of Effective Antiretroviral Therapy: A Primary Healthcare Perspective. QUALITATIVE HEALTH RESEARCH 2022; 32:1487-1497. [PMID: 35770984 PMCID: PMC9411698 DOI: 10.1177/10497323221110801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The prevalence of HIV-associated neurocognitive impairment (H-NCI) is concerning. Individuals on effective antiretroviral therapy (ART) may still be at risk for H-NCI as they experience longer life expectancies. There are, however, few professionals with knowledge and skills to identify H-NCI, in low- and middle-income countries. We explored qualitatively, primary healthcare workers' knowledge and views of H-NCI, in the era of effective ART, particularly their views toward task-sharing of H-NCI screening from specialists to mid-level or lay healthcare providers. The first phase of data collection involved two focus group discussions (FGDs) 23 primary healthcare workers from two facilities in the Western Cape participated in the FGDs. In the second phase of data collection12 individual, in-depth interviews were conducted in KwaZulu-Natal. Using thematic analysis, several key themes emerged. Although healthcare providers were unable to specifically identify H-NCI, they described several HIV disease and treatment related or mental health comorbidities that could be responsible for the symptoms. Despite healthcare workers reporting low frequencies of H-NCI, they favoured receiving training to screen for H-NCI with a view toward providing holistic care.
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Affiliation(s)
- Adele Munsami
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Alford K, Daley S, Banerjee S, Hamlyn E, Trotman D, Vera JH. "A fog that impacts everything": a qualitative study of health-related quality of life in people living with HIV who have cognitive impairment. Qual Life Res 2022; 31:3019-3030. [PMID: 35579729 PMCID: PMC9470604 DOI: 10.1007/s11136-022-03150-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/26/2022]
Abstract
Background Cognitive impairment (CI) in people living with HIV (PLWH) is an important health concern in the context of an ageing HIV population. Impacting 14–28% of PLWH, CI is associated with lower health-related quality of life (HRQoL), however, evaluation of the illness-specific factors comprising HRQoL in PLWH with CI have not been assessed. Objective We sought to contribute evidence toward an understanding of HRQoL and identify domains of HRQoL in PLWH with CI. Methods Qualitative interviews with 25 PLWH with objective CI related to HIV disease were conducted with participants attending HIV clinics in the UK. Clinically significant CI was defined based on The European AIDS Clinical Society guidelines, requiring: (i) subjective reporting of cognitive symptoms; (ii) symptoms to be related to HIV (e.g. potentially confounding non-HIV related conditions have been excluded or are being optimally managed) and; (iii) formal neuropsychological assessment confirming CI. Median age was 56 years (range 35–80); 18 participants were men (72%); 11 (44%) were white British and 8 (32%) were Black African; 14 (56%) were men that have sex with men and 10 (40%) were heterosexual; median number of years living with HIV was 17 (range 1–34); and all participants were on combination antiretroviral therapy. Analyses employed techniques from grounded theory, underpinned by an inductive, collaborative team-based approach. Results Findings revealed seven interrelated domains comprising HRQoL experiences were identified: Physical function, Cognition, Social connectedness, Physical and mental health, Stigma, Self-concept, and Control and acceptance, and each was defined by specific descriptive components. Conclusion This study provides valuable insights on the factors that drive HRQoL in PLWH with CI and contribute to a body of evidence which provides targets for the development of targeted interventions to maintain or improve quality of life.
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Affiliation(s)
- Kate Alford
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Stephanie Daley
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Daniel Trotman
- King's College Hospital NHS Foundation Trust, London, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- University Hospitals Sussex, Sussex, UK
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Ruiz-Robledillo N, Clement-Carbonell V, Ferrer-Cascales R, Portilla-Tamarit I, Alcocer-Bruno C, Gabaldón-Bravo E. Cognitive Functioning and Its Relationship with Self-Stigma in Men with HIV Who Have Sex with Men: The Mediating Role of Health-Related Quality of Life. Psychol Res Behav Manag 2021; 14:2103-2114. [PMID: 34938135 PMCID: PMC8687686 DOI: 10.2147/prbm.s332494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/11/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction The human immunodeficiency virus (HIV) stills remains a serious public health problem. HIV acquisition has several negative health consequences, such as a cognitive deterioration or health-related quality of life (HRQoL) impairment. Although these negative consequences could be directly related to a significant increase in self-stigma in this population, few previous studies have analysed the possible associations between these variables. This is especially the case in specific groups of people living with HIV, such as men who have sex with men who could be at a greater risk of stigmatisation. The main aim of the present study was to evaluate the association between cognitive functioning, HRQoL and self-stigma in a group of men with HIV who have sex with men. Methods The present study was conducted in the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). The final sample was composed of 70 participants who passed the inclusion and exclusion criteria. All were men with HIV who had sex with men and the sample’s mean age was 45 years. Each participant completed questionnaires on HRQoL and HIV self-stigma. Moreover, they completed an online cognitive assessment through the previously validated platform for cognitive evaluation CogniFit, Inc. Results The obtained results showed a significant association between memory functioning impairment, lower levels of HRQoL and higher HIV self-stigma scores. Hence, HRQoL, in the mental summary domain, was shown to be a significant mediator in the relationship between low memory performance and higher HIV self-stigma. Discussion Neurocognitive impairment could decrease HRQoL in men with HIV who have sex with men, and hence, reinforce the idea widespread in society that having HIV holds serious consequences. This fact, together with the reduced cognitive abilities to fight against their own self-stigma could represent plausible explanations of the obtained results. In this sense, intervention strategies, oriented towards reducing cognitive impairment, such as those based on cognitive training, and other psychological interventions to promote HRQoL could be effective approaches to prevent the negative effects of HIV self-stigma in this population.
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Affiliation(s)
- Nicolás Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | | | - Rosario Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Irene Portilla-Tamarit
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Cristian Alcocer-Bruno
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Eva Gabaldón-Bravo
- Department of Nursing, Faculty of Health Science, University of Alicante, Alicante, Spain
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Alford K, Daley S, Banerjee S, Vera JH. Quality of life in people living with HIV-associated neurocognitive disorder: A scoping review study. PLoS One 2021; 16:e0251944. [PMID: 34010362 PMCID: PMC8133427 DOI: 10.1371/journal.pone.0251944] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
Quality of life (QoL) is recognized as an essential end point in the disease management of chronic conditions such as HIV with calls to include good QoL as a ‘fourth 90’ in the 90-90-90 testing and treatment targets introduced by World Health Organization in 2016. Cognitive impairments impact a broad spectrum of experiences and are a common issue effecting people living with HIV (PLWH). Despite this, few studies have examined QoL in PLWH who also have a cognitive disorder. This study aimed to synthesize and describe what is known about QoL in those living with HIV-associated neurocognitive disorders (HAND). A scoping review of peer-reviewed literature was conducted to identify how QoL has been investigated and measured in PLWH with HAND, and how PLWH with HAND report and describe their QoL. We searched PsychInfo, Medline, Scopus, and Web of Science along with hand-searching reference lists from relevant studies found. Included studies were those published in English after 1st January 2003 which included PLWH with cognitive impairment not due to other pre-existing conditions. Fifteen articles met criteria for inclusion. Two studies measured QoL as a primary aim, with others including QoL assessment as part of a broader battery of outcomes. The MOS-HIV and SF-36 were the most commonly used measures of overall QoL, with findings generally suggestive of poorer overall QoL in PLWH with HAND, compared to PLWH without cognitive impairment. Studies which examined dimensions of QoL focused exclusively on functionality, level of independence, and psychological QoL domains. There is a considerable dearth of research examining QoL in PLWH with HAND. The initiatives which advocate for healthy aging and improved QoL in PLWH must be extended to include and understand the experiences those also living with cognitive impairment. Research is needed to understand the broad experiential impacts of living with these two complex, chronic conditions, to ensure interventions are meaningful to patients and potential benefits are not missed.
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Affiliation(s)
- Kate Alford
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, United Kingdom
- * E-mail:
| | - Stephanie Daley
- Centre for Dementia Studies, University of Sussex, Falmer, East Sussex, United Kingdom
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Jaime H. Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, United Kingdom
- Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, United Kingdom
- Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, United Kingdom
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Hardy DJ. Neuroergonomics: A Perspective from Neuropsychology, with a Proposal about Workload. Brain Sci 2021; 11:brainsci11050647. [PMID: 34063553 PMCID: PMC8156258 DOI: 10.3390/brainsci11050647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
In a brief overview of neuroergonomics, including some personal reminiscences of Raja Parasuraman, it is recognized that the field of human factors and ergonomics has benefitted greatly from the inclusion and integration of neuroscientific methods and theory. It is argued that such synergistic success can work in the other direction as well with the inclusion of methods and theory of human factors by a neuro field, in this case, neuropsychology. More specifically, it is proposed that neuropsychology can benefit from the inclusion of workload measures and theory. Preliminary studies on older adults, persons living with HIV, and patients with a traumatic brain injury or multiple sclerosis, are reviewed. As an adjunct measure to neuropsychological tests, the construct of workload seems perfectly suited to provide an additional vector of information on patient status, capturing some of the large individual differences evident in clinical populations and facilitating the early detection of cognitive change.
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Affiliation(s)
- David J. Hardy
- Department of Psychology, Loyola Marymount University, 1 LMU Drive, Los Angeles, CA 90045, USA;
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90045, USA
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Nyamayaro P, Gouse H, Hakim J, Robbins RN, Chibanda D. Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe. BMC Infect Dis 2020; 20:383. [PMID: 32471350 PMCID: PMC7257139 DOI: 10.1186/s12879-020-05090-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/13/2020] [Indexed: 01/24/2023] Open
Abstract
Background HIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV. It typically affects memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning cognitive domains. NCI can affect adherence to antiretroviral therapy (ART), employability, driving ability and activities of daily living. NCI is not routinely screened for in Zimbabwe, and the burden is not known in this setting. The objectives of this study were: 1) To determine NCI prevalence using a comprehensive neuropsychological battery at two primary health care clinics in Harare; 2) To assess the pattern of cognitive impairment across cognitive domains using a gold standard neuropsychological (NP) battery in HIV-positive patients compared to HIV-negative controls. Methods Inclusion criteria: 18 years or older; minimum 7 years education; no neurological or psychiatric disorders. HIV-positive participants were on ART for ≥3 months; HIV-negative participants had a confirmed HIV negative status in the past month. A comprehensive NP battery, functional assessments, demographic and medical history questionnaires were administered. The NP battery consisted of tests assessing memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning. Results Two-hundred-and-thirty-one participants were recruited. Of those, 155 were HIV-positive (Female = 70%, Age M = 37.8; SD 11.2) and 76 HIV-negative (Female = 63%, Age M = 31.2; SD 9.9). HIV-positive participants were on ART for an average of 6 years. NCI was present in 49.7% HIV positive participants. Compared to HIV-negative participants, the HIV-positive group had significantly poorer scores in 5 out of 7 cognitive domains. A good level of education is negatively correlated with NCI. Conclusions NCI prevalence in HIV-positive population Zimbabwe is consistent with global estimates. NCI persists in adults who are on ART. Routine assessment of NCI in adults attending primary care clinics using this adapted battery is therefore important so that they are identified early and are provided the necessary interventions.
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Affiliation(s)
- Primrose Nyamayaro
- Department of Psychiatry, College of Health Sciences, African Mental Health Research Initiative, University of Zimbabwe, Harare, Zimbabwe.
| | - Hetta Gouse
- Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - James Hakim
- Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Reuben N Robbins
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, College of Health Sciences, African Mental Health Research Initiative, University of Zimbabwe, Harare, Zimbabwe.,Centre for Global Mental Health, London School of Hygiene and tropical Medicine, London, UK
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Halpin SN, Ge L, Mehta CC, Gustafson D, Robertson KR, Rubin LH, Sharma A, Vance D, Valcour V, Waldrop-Valverde D, Ofotokun I. Psychosocial Resources and Emotions in Women Living With HIV Who Have Cognitive Impairment: Applying the Socio-Emotional Adaptation Theory. Res Theory Nurs Pract 2020; 34:49-64. [PMID: 31937636 PMCID: PMC8062986 DOI: 10.1891/1541-6577.34.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Decreased cognitive function is related to undesirable psychological outcomes such as greater emotional distress and lower quality of life, particularly among women living with HIV who experience cognitive impairment (WLWH-CI). Yet, few studies have examined the psychosocial resources that may attenuate these negative emotional outcomes. The current study sought to identify the interrelated contributions of social relationships and psychological resources in 399 WLWH-CI by applying Socio-Emotional Adaptation (SEA) theory using data from the Women's Interagency HIV Study (WIHS). Cognitive impairment (CI) was defined as impairment on two or more cognitive domains. Logistic regression models were used to estimate the odds of experiencing specific emotions due to a combination of four psychosocial resources. Emotions (i.e., depression, apathy, fear, anger, and acceptance) were related to a combination of binary (positive/negative) psychosocial resources including relationship with an informal support partner, relationship with a formal caregiver, coping, and perceived control. Understanding the conditions that may influence emotions in WLWH-CI is important for identifying and appropriately addressing the needs of this population. As CI increases, these individuals experience increasing challenges with articulating their care needs and having their needs met. As such, it becomes increasingly important to identify possible triggers for emotional responses to best address these underlying challenges.
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Affiliation(s)
| | - Lin Ge
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Christina C Mehta
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | | | - Kevin R Robertson
- AIDS Neurological Center, Department of Neurology.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Leah H Rubin
- Departments of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Anjali Sharma
- Albert Einstein College of Medicine, Yeshiva University, New York, NY
| | - David Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Victor Valcour
- Global Brain Health Institute, San Franscisco, CA.,Department of Neurology, University of California San Fransisco, San Fransisco, CA
| | | | - Igho Ofotokun
- Emory University School of Medicine, Division of Infectious Disease, Atlanta, GA
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Eaton AD, Walmsley SL, Craig SL, Rourke SB, Sota T, McCullagh JW, Fallon BA. Protocol for a pilot randomised controlled trial evaluating feasibility and acceptability of cognitive remediation group therapy compared with mutual aid group therapy for people ageing with HIV-associated neurocognitive disorder (HAND) in Toronto, Canada. BMJ Open 2019; 9:e033183. [PMID: 31676660 PMCID: PMC6830703 DOI: 10.1136/bmjopen-2019-033183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION HIV-associated neurocognitive disorder (HAND) may affect 30%-50% of people ageing with HIV. HAND may increase stress and anxiety, and impede coping. Psychosocial group therapy may ameliorate HAND's symptoms, yet the ideal intervention is unclear. This protocol outlines a pilot randomised controlled trial (RCT)-designed using community-based participatory research-to pilot cognitive remediation group therapy (CRGT) against an active comparator. METHODS AND ANALYSIS This is a pilot, parallel design, two-arm RCT that will recruit participants diagnosed with the mild neurocognitive disorder form of HAND from a neurobehavioural research unit at a tertiary care hospital in Toronto, Canada. Eligibility criteria include age ≥40 years, known HIV status for 5+ years, English fluency, able to consent and able to attend 8 weeks of group therapy. Eligible participants will be randomised to one of two treatment arms, each consisting of eight-session group interventions delivered once weekly at 3 hours per session. Arm 1 (novel) is CRGT, combining mindfulness-based stress reduction with brain training activities. Arm 2 (active control) is mutual aid group therapy. The primary outcomes are feasibility, measured by proportions of recruitment and completion, and acceptability, determined by a satisfaction questionnaire. The secondary outcome is intervention fidelity, where content analysis will be used to assess facilitator session reports. A between-group analysis will be conducted on exploratory outcomes of stress, anxiety, coping and use of intervention activities that will be collected at three time points. ETHICS AND DISSEMINATION Ethical approval was obtained from the Research Ethics Boards of St. Michael's Hospital and the University of Toronto. Findings will be disseminated through peer-reviewed publications, conference presentations and community reporting. This study could provide insight into design (eg, recruitment, measures) and intervention considerations (eg, structure, content) for a larger trial to lessen the burden of cognitive decline among people ageing with HIV. TRIAL REGISTRATION NUMBER NCT03483740; Pre-results.
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Affiliation(s)
- Andrew David Eaton
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Walmsley
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Sean B Rourke
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Teresa Sota
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Barbara A Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Aung HL, Kootar S, Gates TM, Brew BJ, Cysique LA. How all-type dementia risk factors and modifiable risk interventions may be relevant to the first-generation aging with HIV infection? Eur Geriatr Med 2019; 10:227-238. [DOI: 10.1007/s41999-019-00164-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/09/2019] [Indexed: 11/24/2022]
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12
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Vascular cognitive impairment and HIV-associated neurocognitive disorder: a new paradigm. J Neurovirol 2019; 25:710-721. [DOI: 10.1007/s13365-018-0706-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 02/07/2023]
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