Building Resources to Achieve Improvement in Neurocognition (B.R.A.I.N.) inpeople with HIV.

7.项目摘要/摘要 南非是世界上艾滋病毒携带者最多的国家，约有752万艾滋病毒携带者 (威尔斯亲王医院)。艾滋病毒相关神经认知障碍的患病率很高(23%到76%)，而且仍然很高 甚至在那些被病毒抑制的人中也很流行。然而，没有一项认知康复计划被调整用于 在此设置中的PWH。认知矫正训练是一种很有前途的提高认知技能的干预措施 PWH和认知障碍。我们将结合两种主要的认知补救训练干预 策略、补偿认知训练、行为技能训练方法帮助患者获得 认知和功能技能，以及改善认知的恢复性计算机认知补救培训。 结合这两种策略来解决一系列认知域(例如，信息速度)中的缺陷 加工和工作记忆)在各种精神障碍和衰老过程中都显示出 使日常功能、情绪、控制点和质量得到最大程度的改善 生活的一部分。在通过随机对照试验确定认知矫正训练的有效性之前 背景，认知补救训练必须适应南非的使用，并进行随机对照试验 必须建立这种设置的方法。我们建议调整和合并CogSMART(认知 症状管理和康复治疗)、循证补偿性认知训练，以及 SmartBrainã，基于证据的计算机认知补救，用于也有神经认知的PWH 在南非开展损害评估工作，并探讨在公共诊所使用和今后实施的障碍 通过患者和提供者的面谈。 在研究的第一阶段，我们将1)开发基础设施，以实施认知补救培训 开普敦的初级保健诊所，以及2)使用威尔斯亲王医院工作组和干预工作组 由神经心理学家和职业治疗师组成，以确定认知补救培训 必须在文化上与这一设置相匹配。实施更改并进行翻译后(使用GOLD 标准方法)对科萨语的说明，科萨语是主要的地区语言，研究的第二阶段将试行 在开普敦一所初级卫生机构对40名南非威斯康星妇女进行适应性认知补救训练 护理诊所；以及2)为未来的随机对照试验评估该培训的可用性和可接受性。二 非专业辅导员将负责培训。随机对照试验方法学、可接受性和可行性 将评估：1)拟议的招聘战略(例如，筛选人员的资格和筛选标准)；2) 随机化程序；3)干预前和干预后评估(例如，认知、抗逆转录病毒治疗依从性、艾滋病毒 健康、心理健康和功能状态)；以及4)保留策略。认知矫正训练 可接受性和可行性将评估1)患者的用户体验；以及2)外行顾问的经验 干预管理。

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.