Improving Adherence and Cognition in Substance-Using HIV Patients

提高吸毒艾滋病毒患者的依从性和认知能力

• 批准号: 8145629
• 负责人: RONALD A COHEN
• 金额: $ 32.1万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8145629
• 关键词: Address; Adherence; Affect; Alzheimer' s Disease; Anti-Retroviral Agents; Area; Attention; Behavior; Behavior Therapy; Behavioral; Brain; Chronic; Clinic; Clinical; Cognition; Cognitive; Cognitive remediation; Comorbidity; Computer software; Control Groups; Data; Dementia; Development; Development Plans; Disease; Dose; Drug usage; Effectiveness; Exercise; Feedback; Focus Groups; Frequencies; Functional disorder; Future; HIV; Health; Health Status; Home environment; Impaired cognition; Impairment; Individual; Infection; Instruction; Internet; Intervention; Investigation; Laboratories; Learning; Life; Light; Link; Maintenance; Measures; Memory impairment; Methods; Mind; Modification; Monitor; Moods; Morbidity - disease rate; Motivation; Neurocognitive; Online Systems; Outcome; Participant; Patients; Performance; Pharmaceutical Preparations; Phase; Population; Psychological Transfer; Quality of life; Randomized; Recruitment Activity; Reporting; Research Project Grants; Sampling; Solutions; Substance abuse problem; System; Testing; Therapeutic; Time; Training; Treatment Protocols; Treatment outcome; Update; Validation; Viral Load result; clinically significant; cognitive enhancement; cognitive function; computerized; cost; data acquisition; design; effectiveness trial; efficacy trial; executive function; experience; follow-up; functional outcomes; improved; information processing; interest; mortality; novel; processing speed; programs; public health relevance; recreational drug use; skills; standard care; standard measure; substance abuser; tool; treatment adherence

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.

描述（由申请人提供）：神经认知功能障碍仍然是许多受HIV感染者的重要问题，影响功能结果，健康状况和生活质量。药物滥用障碍（SUD）是临床上最重要的HIV合并症之一，对治疗依从性和长期结局产生负面影响。组织，计划以及其他关注和执行功能通常会受到影响，这反过来又对健康维持行为（包括治疗依从性）产生了不利影响。因此，旨在提高艾滋病毒感染者的认知能力的治疗需求。基于Web的大力思维4.0（VM）认知增强计划为该问题提供了独特的新解决方案，并且是该项目的重点。 VM 4.0已针对患有SUD的HIV患者进行定制，由认知练习和组织工具组成，旨在增强感染HIV感染的SUD患者的注意力执行技能。 VM 4.0结合了使用计算机系统来促进治疗依从性和提高注意力执行技能的方法。 VM具有具有Web交互式用户界面的几个软件模块，并包含大脑练习和组织工具，例如提醒和治疗依从性监测器。此外，它增加了一个新颖的个性化方面，以增加实现更好治疗结果的动力。有力的头脑4.0提供了一种结合认知补救和认知适应性的综合方法。从计划的个性化模块的当前软件和屏幕截图中，从9名患者收集了九名患者的初步可接受性数据，对计划开发产生了一致的有利认可。我们建议进行两期研究。在第一阶段，我们将进行治疗干预措施，其中我们将将经VM组治疗的患者（n = 25）与未经治疗的患者组成的标准护理对照组（n = 25）进行比较。所有参与者将在基线上对临床，神经认知，实验室措施进行评估，并进行全面的SUD评估。 VM将在VM计划上进行12周的培训，而对照组将获得标准护理，两个小组在过去一周内每周接收每周监视其HAART和娱乐毒品使用的电话。 VM使用的持续时间和频率将在此期间通过自动在线数据获取以及练习的性能进行监控。基线评估将在12周中重复，以确定在标准神经认知任务上的表现是否得到改善（转移），以及这些技能是否概括以提高HAART的依从性。参与者将在6个月的随访中重新评估，以检查VM治疗的患者在多大程度上继续使用该计划并保持先前​​的收益。群体间差异将提供VM方法的验证，作为一种易于使用和低成本干预措施，有可能为感染SUD的HIV感染者提供重大功能收益，从而为更大规模的有效性试验提供了基本原理。 公共卫生相关性：旨在提高注意力和执行功能技能的旨在提高艾滋病毒和药物滥用障碍患者管理健康并充分遵守HAART和其他治疗需求的能力。基于Web的大力思维4.0（VM）认知增强计划为该问题提供了独特的新解决方案，是该发展项目和研究调查的重点。拟议研究的目的是确定在该人群中使用的VM计划的开发，并测试其在治疗12周后改善认知功能和HAART依从性的有效性，并在六个月内维持这些收益。