Building Resources to Achieve Improvement in Neurocognition (B.R.A.I.N.) inpeople with HIV. - 7. PROJECT SUMMARY/ABSTRACT
South Africa has the world’s largest HIV population with approximately 7.52 million people with HIV
(PWH). Prevalence of HIV associated neurocognitive impairment is high (23% to 76%) and remains highly
prevalent even among those virally suppressed. Yet, no cognitive rehabilitation program had been adapted for
PWH in this setting. Cognitive remediation training is a promising intervention to improve cognitive skills for
PWH and cognitive impairment. We will combine two predominant cognitive remediation training intervention
strategies, Compensatory Cognitive Training, a behavioral skills training approach to help patients acquire
cognitive and functional skills, and restorative Computer Cognitive Remediation Training to improve cognition.
Combining these two strategies to address deficits in a range of cognitive domains (e.g., speed of information
processing and working memory) has shown, across a variety of psychiatric disorders and in aging
populations, to result in the greatest improvement in everyday functioning, mood, locus of control, and quality
of life. Before efficacy of cognitive remediation training can be determined via randomized controlled trial in this
setting, cognitive remediation training must be adapted for use in South Africa, and randomized control trial
methodology for this setting must be established. We propose to adapt and combine CogSMART (Cognitive
Symptom Management and Rehabilitation Therapy), evidence-based Compensatory Cognitive Training, and
SmartBrainã, evidence-based Computer Cognitive Remediation, for use in PWH who also have neurocognitive
impairment, in South Africa; and to explore barriers to its use and future implementation in public clinics
through patient and provider interviews.
During Phase 1 of the study we will 1) develop infrastructure to implement cognitive remediation training at
primary health care clinics in Cape Town, and 2) use a PWH Work Group and an Intervention Work Group
composed of neuropsychologists and occupational therapists to identify how Cognitive Remediation Training
must be adapted to culturally match this setting. After implementing the changes and translating (using gold
standard methods) instructions to Xhosa, the predominant regional language, Phase 2 of the study will 1) pilot
test the adapted Cognitive Remediation Training among 40 South African PWH in a Cape Town primary health
care clinic; and 2) evaluate usability and acceptability of this training for a future randomized control trail. Two
lay counsellors will administer the training. Randomized control trial methodology, acceptability and feasibility
will assess: 1) proposed recruitment strategy (e.g., eligibility of screeners and screening criteria); 2)
randomization procedures; 3) pre- and post-intervention assessments (e.g., cognition, ART adherence, HIV
health, mental health, and functional status); and 4) retention strategy. Cognitive Remediation Training
acceptability and feasibility will assess 1) patient user experience; and 2) lay counselor experience with
intervention administration.
