Improving Adherence and Cognition in Substance-Using HIV Patients

点击翻译按钮获取中文摘要

DESCRIPTION (provided by applicant): Neurocognitive dysfunction continues to be a significant problem for many HIV-infected people, affecting functional outcome, health status and quality of life. Substance abuse disorders (SUD) are among the most clinically significant HIV co-morbidities, negatively affecting treatment adherence and long-term outcome. Organization, planning and other attention and executive functions are often affected, which in turn adversely impacts health maintenance behaviors, including treatment adherence. Accordingly there is a compelling need for treatments aimed at improving cognitive skills among HIV-infected people with SUDs. The web-based Vigorous Mind 4.0 (VM) cognitive enhancement program provides a unique new solution to this problem and is the focus of this project. VM 4.0, which has been customized for HIV patients with SUD, consists of cognitive exercises and organizational tools designed to enhance the attention-executive skills in HIV-infected people with SUD. VM 4.0 combines the use of a computerized system to promote treatment adherence and enhanced attention-executive skills. VM has several software modules with a web interactive user interface, and contains brain exercises and organizational tools such as reminders and treatment adherence monitors. Furthermore, it adds a novel personalization aspect to increase motivation for achieving better treatment outcomes. Vigorous Mind 4.0 offers an integrated approach to therapy combining cognitive remediation and cognitive accommodation. Preliminary acceptability data collected from nine patients treated for SUD using the current software and screen shots of the planned personalized modules yielded unanimous favorable endorsement of the planned development. We propose to a two phase study. In Phase I, we will conduct a treatment intervention in which we will compare a group VM treated patients (n=25) to a standard care control group of untreated patients (n = 25). All participants will be assessed at baseline on clinical, neurocognitive, laboratory measures, as well as undergo a comprehensive SUD assessment. The VM will train on the VM program for 12 weeks, while the control group will receive standard care, with both groups receiving weekly calls to monitor their HAART and recreational drug use over the past week. The duration and frequency of VM usage will be monitored during this period through automatic on-line data acquisition, along with performance on the exercises. The baseline assessment will be repeated at 12-weeks to determine whether performance on standard neurocognitive tasks improved (transfer), and whether these skills generalize to increase HAART adherence. Participants will be reassessed at a 6-month follow-up to examine the extent to which VM treated patients continue to use the program and maintain previous gains. Significant between-group difference will provide validation of the VM approach as an easy-to-use and low cost intervention that has the potential to provide significant functional benefits for HIV-infected people with SUD, providing rationale for a larger scale effectiveness trial. PUBLIC HEALTH RELEVANCE: There is a compelling need for treatments aimed at improving attention and executive functional skills, in order to ultimately enhance the ability of people with HIV and substance abuse disorders to manage their health and adequately adhere to HAART and other treatment demands. The web-based Vigorous Mind 4.0 (VM) cognitive enhancement program provides a unique new solution to this problem and is the focus of this developmental project and research investigation. The aim of the proposed study is to finalize development of the VM program for use in this population and to test its effectiveness for improving cognitive function and HAART adherence after 12 weeks of treatment and to maintain these gains over six months.