The intersecting cognitive and aging needs of HIV-positive older adults: Implications for social work practice

Eaton, Andrew; Craig, Shelley L.; Wallace, Robert

doi:10.1080/00981389.2017.1339759

Cited by 21 publications

(29 citation statements)

References 23 publications

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“…Community-based participatory research (CBPR) and implementation science guided an approach to engage people ageing with HIV and affected by HAND, alongside service providers and HAND researchers, as the protocol was being developed. First, an exploratory CBPR study surveyed (n=108) and interviewed (n=20) people ageing with HIV in Ontario; approximately one-eighth of participants had been diagnosed with HAND and the entirety of the sample self-identified recently reduced function and ability in more than one cognitive domain (eg, memory, speed-of-processing) 12. The purpose of this initial study was to determine the direction for psychosocial interventions in HIV and cognition, with a focus on social work due to the profession’s history of effective engagement with people living with HIV 23 30.…”

Section: Methods: Participants Interventions and Outcomesmentioning

confidence: 99%

“…HAND symptoms include memory deficits, problem-solving errors, difficulties in processing new information, executive function impairment and poor decision-making 3–8. This, in turn, leads to stress, anxiety, social isolation, difficult coping and impacts daily activities (eg, medication adherence) 11–13. HAND differs from Alzheimer’s disease and other cognitive impairments in numerous clinical areas 7.…”

Section: Introductionmentioning

confidence: 99%

“…With cognitive decline from normal ageing and other syndemic factors (eg, intersecting HIV and ageing comorbidities), HAND symptoms are amplified and further impair the ageing HIV-infected adult’s ability to cope 13. With the earlier age of impairment and syndemic factors associated with HIV, HAND may be a condition in need of specific psychosocial intervention distinct from what is currently being tested in geriatric adults with dementia 12 14. Yet despite exploratory research on the unique challenges of HAND and a stated community need,11 12 15–17 HAND intervention research in the era of modern cART is limited and the optimal intervention is unclear 13 14…”

Section: Introductionmentioning

confidence: 99%

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Protocol for a pilot randomised controlled trial evaluating feasibility and acceptability of cognitive remediation group therapy compared with mutual aid group therapy for people ageing with HIV-associated neurocognitive disorder (HAND) in Toronto, Canada

et al. 2019

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IntroductionHIV-associated neurocognitive disorder (HAND) may affect 30%–50% of people ageing with HIV. HAND may increase stress and anxiety, and impede coping. Psychosocial group therapy may ameliorate HAND’s symptoms, yet the ideal intervention is unclear. This protocol outlines a pilot randomised controlled trial (RCT)—designed using community-based participatory research—to pilot cognitive remediation group therapy (CRGT) against an active comparator.Methods and analysisThis is a pilot, parallel design, two-arm RCT that will recruit participants diagnosed with the mild neurocognitive disorder form of HAND from a neurobehavioural research unit at a tertiary care hospital in Toronto, Canada. Eligibility criteria include age ≥40 years, known HIV status for 5+ years, English fluency, able to consent and able to attend 8 weeks of group therapy. Eligible participants will be randomised to one of two treatment arms, each consisting of eight-session group interventions delivered once weekly at 3 hours per session. Arm 1 (novel) is CRGT, combining mindfulness-based stress reduction with brain training activities. Arm 2 (active control) is mutual aid group therapy. The primary outcomes are feasibility, measured by proportions of recruitment and completion, and acceptability, determined by a satisfaction questionnaire. The secondary outcome is intervention fidelity, where content analysis will be used to assess facilitator session reports. A between-group analysis will be conducted on exploratory outcomes of stress, anxiety, coping and use of intervention activities that will be collected at three time points.Ethics and disseminationEthical approval was obtained from the Research Ethics Boards of St. Michael’s Hospital and the University of Toronto. Findings will be disseminated through peer-reviewed publications, conference presentations and community reporting. This study could provide insight into design (eg, recruitment, measures) and intervention considerations (eg, structure, content) for a larger trial to lessen the burden of cognitive decline among people ageing with HIV.Trial registration numberNCT03483740

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Section: Methods: Participants Interventions and Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Protocol for a pilot randomised controlled trial evaluating feasibility and acceptability of cognitive remediation group therapy compared with mutual aid group therapy for people ageing with HIV-associated neurocognitive disorder (HAND) in Toronto, Canada

et al. 2019

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“…In the absence of and even alongside an eventual pharmacological remedy, psychosocial approaches are needed to improve coping with HAND's symptoms 17 . Although existing research has illuminated unique cognitive challenges amongst people aging with HIV 18 , such as a higher prevalence of cognitive impairment at an earlier age 19 than the general population and dual stigma associated with HIV and cognitive challenges 20 , psychosocial interventions have not yet been well tested for people aging with HIV and the optimal approach is unknown 21 .…”

Section: Introductionmentioning

confidence: 99%

Cognitive remediation group therapy versus mutual aid group therapy: A pilot randomized, controlled trial to determine the feasibility and acceptability of group therapy for people aging with HIV facing cognitive challenges

Eaton¹,

Craig²,

Rourke³

et al. 2020

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Background: Cognitive impairment is an important comorbidity for people aging with HIV, yet we lack non-medical techniques to address the associated anxiety and stress. Combination psychosocial interventions may have better outcomes than single technique approaches. Mindfulness-Based Stress Reduction (MBSR) and tablet-based Brain Training Activities (BTA) are promising techniques. Using community-based participatory research, our objective was to determine the feasibility and acceptability of group therapy for HIV, aging, and cognition.Methods: A pilot, parallel design, two-arm RCT recruited from a Toronto neurobehavioural research unit. Eligibility criteria included: diagnoses with mild-to-moderate HIV-associated neurocognitive disorder (HAND), age ≥ 40 years, HIV-positive for 5+ years, and English fluency. Randomization was 1:1 concealed allocation to Cognitive Remediation Group Therapy (Experimental; combination of BTA and MBSR) or Mutual Aid Group Therapy (Control). Primary outcomes were feasibility, measured by recruitment and completion, and acceptability, determined by a satisfaction questionnaire. The secondary outcome was intervention fidelity, assessed via facilitator session reports. Exploratory outcomes were anxiety, stress, coping, and use of mindfulness and brain training activities.Facilitators and analysts were blinded, however participants were not. eligible participants were contacted, 12 randomized, and 10 completed the study and were analyzed for outcomes. The trial met its a priori feasibility targets with 30% recruited and 25% completed. At post-intervention, acceptability was 90% in the novel and 85% in the control arm. Assessors confirmed intervention delivery with satisfactory fidelity, with no missing components or significant deviations. Anxiety decreased for all in the novel arm and half of the control. Stress decreased and coping increased for half in both arms. All participants increased and sustained BTA use and half with mindfulness activities. There were no reported study harms.Conclusions: Although the combination of BTA and MBSR proved equal or slightly better to mutual aid therapy on all outcomes, recruitment of people with a formal HAND diagnosis from a single site was challenging. We recommend that future exploration of these techniques broaden to those aging with Human Immunodeficiency Virus MBSR Mindfulness-Based Stress Reduction Declarations Ethics approval and consent to participateThis study was approved by the Research Ethics Boards of and the University of Toronto (35860). Informed consent was obtained from all study participants. Consent for publicationNot applicable.

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“…Although research has been conducted to identify factors related to the standardization of diagnostic screening tools, classification, and clinical treatment options for HAND (Elbirt et al, 2015;Sanmarti et al, 2014;Zipursky et al, 2013), as well as challenges related to the lived experience of PLWH and neurocognitive impairment that emphasize the need for appropriate and accessible rehabilitative services (Eaton, Craig, & Wallace, 2017;Gallagher et al, 2013;Hopcroft et al, 2013), to date, there has been no research carried out to identify the potential barriers service providers face with regard to addressing HAND in their work. The main objective of this study was to address this research gap.…”

mentioning

confidence: 99%

Barriers to addressing HIV-Associated neurocognitive disorder (HAND): Community-based service provider perspectives

Liboro

Ibáñez-Carrasco

Rourke

et al. 2018

Journal of HIV/AIDS & Social Services

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HIV-Associated Neurocognitive Disorder (HAND) is an emergent public health issue in developed countries. Consequently, people living with HIV who experience HAND will increasingly require support from community-based HIV service providers. The objective of our qualitative study was to identify barriers service providers face in addressing HAND among people living with HIV. Thirty-three providers from 22 AIDS service organizations across Ontario, Canada, were interviewed. Using thematic analysis, three types of barriers were identified: (a) personal/ professional, (b) service access, and (c) systemic. This paper draws attention to HAND-related obstacles that service providers encounter in their work and presents options to overcome them.

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The intersecting cognitive and aging needs of HIV-positive older adults: Implications for social work practice

Cited by 21 publications

References 23 publications

Protocol for a pilot randomised controlled trial evaluating feasibility and acceptability of cognitive remediation group therapy compared with mutual aid group therapy for people ageing with HIV-associated neurocognitive disorder (HAND) in Toronto, Canada

Protocol for a pilot randomised controlled trial evaluating feasibility and acceptability of cognitive remediation group therapy compared with mutual aid group therapy for people ageing with HIV-associated neurocognitive disorder (HAND) in Toronto, Canada

Cognitive remediation group therapy versus mutual aid group therapy: A pilot randomized, controlled trial to determine the feasibility and acceptability of group therapy for people aging with HIV facing cognitive challenges

Barriers to addressing HIV-Associated neurocognitive disorder (HAND): Community-based service provider perspectives

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