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

7.项目概要/摘要 南非是世界上艾滋病毒感染者最多的国家，约有752万人感染艾滋病毒。 （威尔斯亲王医院）。艾滋病毒相关的神经认知障碍的患病率很高（23%至76%）， 甚至在病毒抑制者中也普遍存在。然而，没有认知康复计划被改编为 在这种情况下PWH。认知补救训练是一种很有前途的干预措施，可以提高认知技能， PWH和认知障碍。我们将结合联合收割机两种主要的认知补救训练干预 策略，补偿认知训练，一种行为技能训练方法，帮助患者获得 认知和功能技能，以及恢复性计算机认知补救训练，以提高认知能力。 结合这两种策略来解决一系列认知领域的缺陷（例如，信息速度 加工和工作记忆）已经显示，在各种精神疾病和衰老中， 人口，导致日常功能，情绪，控制点和质量的最大改善 生命在认知矫正训练的有效性可以通过随机对照试验确定之前， 设置，认知补救培训必须适应在南非使用，并随机对照试验 必须建立这方面的方法。我们建议调整和联合收割机CogSMART（认知 症状管理和康复治疗），循证补偿认知训练，以及 SmartBrainã，循证计算机认知补救，用于患有神经认知障碍的PWH 并探讨其使用和未来在公共诊所实施的障碍 通过患者和供应商的访谈。 在研究的第1阶段，我们将1）开发基础设施，以实施认知补救培训， 开普敦的初级卫生保健诊所，以及2）使用PWH工作组和干预工作组 由神经心理学家和职业治疗师组成，以确定认知矫正训练 必须适应这种文化背景。实施更改并翻译（使用黄金）后 标准方法）说明科萨语，主要的地区语言，研究的第二阶段将1）试点 在开普敦初级卫生保健中心的40名南非PWH中测试适应的认知补救培训 护理诊所;和2）评估未来随机对照试验中该培训的可用性和可接受性。两 培训由非专业辅导员负责。随机对照试验方法、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，ART依从性，HIV 健康，心理健康和功能状态）;和4）保留策略。认知矫正训练 可接受性和可行性将评估1）患者用户体验;和2）非专业顾问的经验， 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.