Tuesday, September 26, 2023
9/26/2023
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.
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