Memory-Based Strategies for Antiretroviral Medication Management: An Evaluation of Clinical Predictors, Adherence Behavior Awareness, and Effectiveness

Blackstone, Kaitlin; Woods, Steven Paul; Weber, Erica; Grant, Igor; Moore, David J.

doi:10.1007/s10461-012-0308-9

Cited by 16 publications

(9 citation statements)

References 38 publications

(50 reference statements)

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“…Although diabetes was not able to be included in the multivariable model, those with diabetes appear to be less likely to default. It is possible that those patients on treatment for diabetes are already in the habit of taking daily medication or simply more comfortable with the healthcare system [ 30 – 32 ]. To learn more about this relationship and any potential explanations, future studies could look at preexisting medication routines and their effects on adherence to TB treatment.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics Associated with Tuberculosis Treatment Default: A Cohort Study in a High-Incidence Area of Lima, Peru

Lackey¹,

Seas

Stuyft

et al. 2015

PLoS ONE

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BackgroundAlthough tuberculosis (TB) is usually curable with antibiotics, poor adherence to medication can lead to increased transmission, drug resistance, and death. Prior research has shown several factors to be associated with poor adherence, but this problem remains a substantial barrier to global TB control. We studied patients in a high-incidence district of Lima, Peru to identify factors associated with premature termination of treatment (treatment default).MethodsWe conducted a prospective cohort study of adult smear-positive TB patients enrolled between January 2010 and December 2011 with no history of TB disease. Descriptive statistics and multivariable logistic regression analyses were performed to determine risk factors associated with treatment default.ResultsOf the 1233 patients studied, 127 (10%) defaulted from treatment. Patients who defaulted were more likely to have used illegal drugs (OR = 4.78, 95% CI: 3.05-7.49), have multidrug-resistant TB (OR = 3.04, 95% CI: 1.58-5.85), not have been tested for HIV (OR = 2.30, 95% CI: 1.50-3.54), drink alcohol at least weekly (OR = 2.22, 95% CI: 1.40-3.52), be underweight (OR = 2.08, 95% CI: 1.21-3.56), or not have completed secondary education (OR = 1.55, 95% CI: 1.03-2.33).ConclusionsOur study identified several factors associated with defaulting from treatment, suggesting a complex set of causes that might lead to default. Addressing these factors individually would be difficult, but they might help to identify certain high-risk patients for supplemental intervention prior to treatment interruption. Treatment adherence remains a barrier to successful TB care and reducing the frequency of default is important for both the patients’ health and the health of the community.

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Section: Discussionmentioning

confidence: 99%

Patient Characteristics Associated with Tuberculosis Treatment Default: A Cohort Study in a High-Incidence Area of Lima, Peru

Lackey¹,

Seas

Stuyft

et al. 2015

PLoS ONE

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“…These findings have practical implications for treatment providers, particularly when prescribing medications to people with HIV infection, MA use, or both; for instance, all three of these groups may struggle with medication adherence and simply providing prescriptions may not be sufficient to carry through treatment. In fact, even when HIV individuals with everyday functioning difficulties (i.e., IADL dependence, unemployment) implement their own compensatory strategies, they are not able to attain sufficient levels of adherence (Blackstone et al in press). …”

Section: Discussionmentioning

confidence: 99%

Human Immunodeficiency Virus Infection Heightens Concurrent Risk of Functional Dependence in Persons With Long-Term Methamphetamine Use

Blackstone

Iudicello

Morgan

et al. 2013

Journal of Addiction Medicine

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Objectives The causes of disability among chronic methamphetamine (MA) users are multifactorial. The current study examined the additive adverse impact of human immunodeficiency virus (HIV) infection, a common comorbidity in MA users, on functional dependence. Methods A large cohort of participants (N=798) stratified by lifetime MA dependence diagnoses (i.e., MA+ or MA−) and HIV serostatus (i.e., HIV+ or HIV−) underwent comprehensive baseline neuromedical, neuropsychiatric, and functional research evaluations, including assessment of neurocognitive symptoms in daily life, instrumental and basic activities of daily living, and employment status. Results Independent, additive effects of MA and HIV were observed across all measures of functional dependence, independent of other demographic, psychiatric, and substance use factors. The prevalence of global functional dependence increased in the expected stepwise fashion across the cohort, with the lowest rates in the MA−/HIV− group (29%) and the highest rates in the MA+/HIV+ sample (69%). The impact of HIV on MA-associated functional dependence was moderated by nadir CD4 count, such that MA use was associated with greater disability among those HIV-infected persons with higher, but not lower nadir CD4. Within the MA+/HIV+ cohort, functional dependence was reliably associated with neurocognitive impairment, lower cognitive reserve, polysubstance use, and major depressive disorder. Conclusions HIV infection confers an increased concurrent risk of MA-associated disability, particularly among HIV-infected persons without histories of immune compromise. Directed referrals, earlier HIV treatment, and compensatory strategies aimed at counteracting the effects of low cognitive reserve, neurocognitive impairment, and psychiatric comorbidities on functional dependence in MA+/HIV+ individuals may be warranted.

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“…Given the fact that the 24-hr delay trial has only a single data point and thus suffered from low power (compared to number of data points and associated power of the TB scale), this trend level effect suggests that lab-based data can potentially translate to the more naturalistic time-based tasks of everyday life (Blackstone et al, in press). However, one other possible interpretation is that the HAND group may have employed compensatory strategies (e.g., a note to oneself) for the 24-hr task; as such, the use of such a strategy would lessen the need for strategic time monitoring, and would increase reliance on automatic processing.…”

Section: Discussionmentioning

confidence: 99%

Prospective memory in HIV-associated neurocognitive disorders (HAND): The neuropsychological dynamics of time monitoring

Doyle

Loft

Morgan

et al. 2013

Journal of Clinical and Experimental Neuropsychology

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Strategic monitoring during a delay interval is theorized to be an essential feature of time-based prospective memory (TB PM), the cognitive architecture of which is thought to rely heavily on frontostriatal systems and executive functions. This hypothesis was examined in 55 individuals with HIV-associated neurocognitive disorders (HAND) and 108 seronegative comparison participants who were administered the Memory for Intentions Screening Test (MIST), during which time monitoring (clock checking) behavior was measured. Results revealed a significant interaction between HAND group and the frequency of clock checking, in which individuals with HAND monitored checked the clock significantly less often than the comparison group across the TB PM retention intervals of the MIST. Subsequent analyses in the HAND sample revealed that the frequency of clocking checking was positively related to overall TB performance, as well as to standard clinical measures of retrospective memory and verbal fluency. These findings add support to a growing body of research elucidating TB PM’s reliance on strategic monitoring processes dependent upon intact frontostriatal systems. HIV-associated TB strategic time monitoring deficits may manifest in poorer functioning outcomes, including medication non-adherence and dependence in activities of daily living. Future research is needed to further delineate the cognitive mechanisms underlying strategic time monitoring in order to advise rehabilitation strategies for reducing HAND related TB PM deficits.

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Memory-Based Strategies for Antiretroviral Medication Management: An Evaluation of Clinical Predictors, Adherence Behavior Awareness, and Effectiveness

Cited by 16 publications

References 38 publications

Patient Characteristics Associated with Tuberculosis Treatment Default: A Cohort Study in a High-Incidence Area of Lima, Peru

Patient Characteristics Associated with Tuberculosis Treatment Default: A Cohort Study in a High-Incidence Area of Lima, Peru

Human Immunodeficiency Virus Infection Heightens Concurrent Risk of Functional Dependence in Persons With Long-Term Methamphetamine Use

Prospective memory in HIV-associated neurocognitive disorders (HAND): The neuropsychological dynamics of time monitoring

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