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

建立资源以改善艾滋病毒感染者的神经认知 (B.R.A.I.N.)。

基本信息

批准号：
10596191
负责人：
Hetta-Mari Gouse
金额：
$ 23.26万
依托单位：
UNIVERSITY OF CAPE TOWN
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10596191
关键词：
Acquired Immunodeficiency Syndrome Activities of Daily Living Address Affect Africa Aging Anti-Retroviral Agents Attention Behavioral Caring Clinic Cognition Cognitive Cognitive remediation Communities Computers Consultations Control Groups Control Locus Decision Making Disease Educational Intervention Eligibility Determination Epidemic Focus Groups Future Goals Grant HIV HIV Infections HIV-associated neurocognitive disorder Health Health Benefit Health Status Healthcare Healthcare Systems Impaired cognition Incidence Infrastructure Instruction Intervention Intervention Studies Interview Language Life Expectancy Linguistics Measures Medical Mental Health Mental disorders Methodology Methods Moods Neurobehavioral Manifestations Neurocognition Neurocognitive Deficit Occupational Therapist Outcome Patients Persons Physicians Pilot Projects Population Prevalence Primary Health Care Procedures Process Professional counselor Provider Psyche structure Public Health Quality of life Randomized Randomized, Controlled Trials Rehabilitation therapy Research Research Methodology Research Personnel Resource-limited setting Resources Risk Short-Term Memory South Africa South African Specialist Speed Technology Testing Time Training Translating United States National Institutes of Health Unsafe Sex Viral Work acceptability and feasibility aging population antiretroviral therapy cognitive rehabilitation cognitive skill cognitive training comorbidity computerized daily functioning depressive symptoms evidence base experience functional status future implementation improved information processing infrastructure development medication compliance mental state neighborhood disadvantage novel phase 1 study phase 2 study physical conditioning pilot test post intervention processing speed programs psychosocial recruit retention rate screening skills skills training sociodemographics socioeconomic disadvantage symptom management therapy adherence therapy development usability working group

项目摘要

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.

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 万艾滋病毒感染者 (PWH) 与 HIV 相关的神经认知障碍的患病率很高（23% 至 76%），并且仍然很高。即使在病毒受到抑制的人中也很普遍，但尚未采取任何认知康复计划。在这种情况下，认知矫正训练是一种很有前景的干预措施，可以提高患者的认知技能。我们将结合两种主要的认知矫正训练干预。策略，补偿性认知训练，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修复训练，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，信息的速度）处理和工作记忆）已表明，在各种精神疾病和衰老过程中人群的日常功能、情绪、控制点和质量得到最大程度的改善在认知矫正训练的效果可以通过随机对照试验确定之前环境，认知矫正训练必须适应在南非的使用，以及随机对照试验我们建议采用并结合 CogSMART（认知）来建立这种设置的方法。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修复，适用于也有神经认知障碍的感染者南非的障碍；并探讨其在公共诊所的使用和未来实施的障碍通过患者和提供者访谈。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如何在实施更改和翻译后（使用黄金）必须进行调整以在文化上匹配此设置。标准方法）对主要地区语言科萨语的说明，研究的第二阶段将 1）试点在开普敦初级卫生保健中心对 40 名南非感染者进行适应性认知矫正训练测试护理诊所；2) 评估该培训对于未来随机对照试验的可用性和可接受性。非专业顾问将管理随机对照试验方法、可接受性和可行性。将评估： 1) 拟议的招聘策略（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 4）认知矫正训练。可接受性和可行性将评估 1) 患者用户体验；以及 2) 非专业咨询师的经验干预管理。