Informing Adults With HIV of Cognitive Performance Deficits Indicative of HIV-Associated Neurocognitive Disorder: A Content Analysis

Abstract

Approximately 50% of persons with HIV (PWH) meet the cognitive criteria for HIV-associated neurocognitive disorder (HAND). Informing PWH they may have HAND raises concerns given the lack of consensus-derived treatment options and overall knowledge about HAND. Thus, the current qualitative descriptive study aimed to describe PWHs' reactions to a possible diagnosis of HAND. Cognitive tests were administered to 135 PWH to determine whether they met the criteria for HAND. From 135 PWH, 109 (80.7%) participants met the cognitive criteria and were informed about their probable HAND diagnosis. Approximately 2 months later, the remaining 85 participants (24 were lost to attrition) were asked about their reactions and concerns to receiving a probable diagnosis of HAND. Their responses were thematically coded. Themes that emerged were Desire to Improve, Confirmation, Not Concerned/No Reaction, Concerned, Unexpected, Anxiety, Knowledge Seeking, and Sadness . Most themes were positive or neutral, whereas fewer negative themes were observed. Thematic/content analysis appeared to show that most PWH reacted well to their probable diagnosis and were open to ways to improve their brain health. Such openness represents a window to provide health education to patients. Implications for practice and research are provided. [ Journal of Psychosocial Nursing and Mental Health Services, 57 (12), 48–55.].

A Randomized Clinical Trial on the Impact of Individually Targeted Computerized Cognitive Training on Quality of Life Indicators in Adults With HIV-Associated Neurocognitive Disorder in the Southeastern United States

“…The primary aim of the TOPS study was to reduce the severity of HAND and reverse the diagnosis using a framework to deliver individually targeted domain-specific cognitive training (Vance et al, 2018a). Using a neuropsychological algorithm called the Frascati criteria, HAND is diagnosed using a norm-based (age/education) neurocognitive battery when cognitive impairment (<1 SD below the normative mean) is detected in two or more cognitive domains (i.e., attention, SOP, verbal learning and memory, delayed verbal memory, executive functioning, spatial learning and memory, delayed spatial memory, and spatial visualization; Blackstone et al, 2012; Vance et al, 2017).…”

“…To address this, a cognitive training algorithm was created that theoretically would best target the cognitive domains needed to reverse a HAND diagnosis. Thus, the three-step Individualized-Targeted Cognitive Training Framework (Vance et al, 2018b) was created. In Step one, if cognitive impairments were detected in either SOP and/or attention, participants were automatically assigned cognitive training in these domains.…”

“…Thus, a global deficit score of five or higher indicates HAND (Blackstone et al, 2017). In clinical practice, other factors, such as comorbidities or impairments in everyday functioning, are taken into consideration when diagnosing HAND; however, in our study, only cognitive performance was used to make this diagnosis (i.e., all participants met criteria for at least asymptomatic neurocognitive impairment) because cognition is the key component of HAND (For details about HAND, the cognitive measures, and TOPS protocol procedures, see Vance et al, 2018a).…”

“…A related study demonstrated that cognitive training may also improve sleep quality in older adults (Cody et al, 2020). These QoL outcomes are crucial areas in HIV that also require intervention (Vance et al, 2018a).…”

The Intersection of Cognitive Ability and HIV: A Review of the State of the Nursing Science

“…Moreover, there is no standard of care to treat HAND (Vance et al, 2013; Saylor et al, 2016), making it questionable to give such diagnostic labels to PLWH, thereby causing undue stress. In a cognitive training study of 109 participants (87% Black, 11.8% White, and 1.2% Hispanic) who met the criteria for HAND, Vance, Jensen, et al (2019) informed participants by letter that they met the probable diagnosis of HAND. Weeks later, participants were asked how they reacted to this diagnostic information.…”