Cognitive functioning, depression, and HIV medication adherence in India: a randomized pilot trial

Abstract

Objective: India is home to the third-largest number of people living with HIV in the world, and no-cost antiretroviral therapy (ART) has been available across the country since 2004. However, rates of adherence to ART are often subpar in India, and interventions to increase adherence are warranted. Cognitive impairment and depression have been associated with ART non-adherence, and may also limit the impact of behavioral interventions designed to improve adherence. Studies have not evaluated the impact of cognitive impairment and depression on response to adherence interventions in India. Methods: Individuals new to ART (≤12 months prescribed) were recruited from a public hospital in Chandigarh, India. Participants (N = 80) were randomized to either a group medication adherence intervention (MAI) or an enhanced standard of care (ESOC) condition. The MAI consisted of three monthly gender-concordant group cognitive-behavioral sessions addressing HIV and ART, adherence, and HIV-related coping and social support. Participants were assessed at baseline for depression and cognitive functioning, and assessed monthly for adherence by pill count. Results: Adherence among participants receiving the MAI improved by about one day's dose over the course of the study, and no improvement was noted among those in the ESOC. Additionally, high rates of cognitive impairment (57%) and depression (25%) were identified among participants. There was no evidence that cognitive impairment moderated response to the intervention. However, while non-depressed participants benefitted from the intervention, depressed participants failed to show the same improvement. Conclusions: Results of this pilot study suggest that group behavioral interventions can be an effective strategy to promote ART adherence in this population, even among those demonstrating cognitive impairment. However, because of the negative impact of depression on adherence, future studies should continue to develop strategies to identify and treat it among people living with HIV in India.

Treatment Engagement Moderates the Effect of Neurocognitive Impairment on Antiretroviral Therapy Adherence in HIV-Infected Drug Users in Treatment

“…Our results emphasized the impact of NCI, as it showed the main effect on ART adherence. Consistent with previous findings, our study showed the significant effect of the presence and severity of NCI on decreased ART adherence (Cook et al, 2014; Hinkin et al, 2002; Malee et al, 2009; Waldrop-Valverde, Jones, Weiss, Kumar, & Metsch, 2008). This finding was significant for HIV-infected individuals, particularly PWUDs, who had a greater likelihood of being cognitively impaired, exhibiting depressive symptoms, and reduced social support due to disease process, lifestyles, and chronic substance use behaviors (Bhatia, Hartman, Kallen, Graham, & Giordano, 2011; Scheyett et al, 2010; Zahari et al, 2010).…”

Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: A systematic review of the literature

“…12 studies described counseling interventions that were delivered to individuals, groups, or combined individual and group sessions [ 47 – 52 , 54 , 56 – 58 , 60 , 61 ]. Two studies were conducted among adolescents only [ 58 , 60 ], two among both adults and adolescents [ 50 , 61 ], and eight among adults only [ 47 – 49 , 51 , 52 , 54 , 56 , 57 ]. Three additional studies that combined individual counseling with SMS reminders are described in the following section.…”

“…Group counseling interventions were described in seven studies, five of which were conducted among adults [ 51 , 52 , 54 , 56 , 57 ] and two among adolescents [ 58 , 60 ].…”

Neurocognitive functioning among HIV-positive adults in southern India

“…The proportion of individuals speaking Telegu in the HIV+ group was significantly lower compared to the HIV− group, warranting cautious interpretation of the group differences in cognitive functioning. Other studies in different geographically/linguistically distinct regions of India have reported mild to moderate cognitive deficits in individuals with HIV-1 Clade C infection 11,12,24 . Our findings are consistent with prior reports of HIV-associated cognitive impairments in Clade C infected cohorts.…”

“…Our findings are consistent with prior reports of HIV-associated cognitive impairments in Clade C infected cohorts. Of note, these studies in Karnataka 12 , Chandigarh 24 , and Pune 11 , as well as our study in Chennai, vary in their study design (e.g., presence or absence of control group), HIV disease characteristics, and assessment approach (e.g., batteries and individual tests used, language of administration). Thus, direct comparisons across studies are not possible; however, there is evidence for a general trend of HIV-associated neurocognitive disorders in diverse Indian cohorts.…”