Neurocognitive decline as a major predictor of nonadherence to antiretroviral therapy among adults living with HIV in Dodoma region, central Tanzania

Abstract

Background The survival of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome largely depends on good adherence to antiretroviral medications. Neuropsychiatric conditions such as major depressive disorders (MDDs) and neurocognitive disorders, in particular, are common in the HIV population and attributed to suboptimal adherence to antiretroviral treatment and overall poor clinical outcomes. This study aimed to determine the association between neurocognitive disorders and nonadherence to antiretroviral therapy (ART) in the Dodoma region's adult population living with HIV. Methods The study was conducted in Dodoma Regional Referral Hospital using a cross‐sectional design to assess 397 participants through a systematic sampling approach. Montreal Cognitive Assessment was used to determine neurocognitive function, while the Simplified Medical Adherence Questionnaire was used to assess nonadherence to ART. Logistic regression analysis was computed to determine the association between cognitive decline and nonadherence to ART while controlling for sociodemographic and clinical confounders. Results Out of the 397 recruited participants, 266 (67.00%) and 41 (10.33%) met the criteria for neurocognitive decline and nonadherence to ART. Participants with cognitive impairment had a significantly poorer adherence rate than those without, even after controlling for confounders adjusted odds ratio (aOR): 2.183 (95% confidence interval [CI]: 1.031, 4.630, p = 0.0413). MDD was the only additional factor that remained significantly associated with ART nonadherence (aOR: 4.332, 95% CI: 1.634, 11.485, p = 0.0032). Conclusion Neurocognitive disorders are strong predictor of suboptimal adherence to ART; a comorbid neuropsychiatric condition such as MDD may further compromise the ART adherence rate leading to poor HIV care and poor clinical outcome. Further research with systematic and more robust studies in the field will provide a baseline to design and integrate appropriate care models to maximize ART adherence in HIV care. Integration of psychiatric services in HIV care can benefit the overall patient outcome.

Correlates of the HIV-associated neurocognitive disorders among adults living with HIV in Dodoma region, central Tanzania: A cross-sectional study

“…Our study showed that suboptimal adherence was significantly associated with neurocognitive impairment. Other studies have also shown that neurocognitive impairment is a major predictor of poor adherence to ART [ 74 ]. However, the temporal relationship between poor adherence and poor cognitive functioning is unclear.…”

Accelerated aging in people living with HIV: The neuroimmune feedback model

“…Neurocognitive impairment, which is frequently comorbid with depression and problematic substance use, may also play a role in ART non-adherence ( Nyundo, 2022 ; Rubin and Maki, 2019 ; Thaler et al, 2015 ). Along these lines, one study reported that PLWH with HIV-associated neurocognitive disorder had lower resting state functional connectivity in the CEN compared to healthy control participants ( Chaganti et al, 2017 ).…”

Cognitive Performance, as well as Depression, Alcohol Use, and Gender, predict Anti-Retroviral Therapy Adherence in a South African Cohort of People with HIV and Comorbid Major Depressive Disorder

“…Among these few studies, findings are equivocal and methods may be suboptimal. For instance, whereas a study conducted in Malawi found no relationship between cognitive impairment and adherence [ 25 ], another one conducted in Tanzania [ 26 ] found that impaired cognitive performance was a strong predictor of suboptimal adherence. However, this latter study used only the Montreal Cognitive Assessment (MoCA), a screening tool, to measure cognitive performance.…”

“…Most studies investigating the association between cognitive performance and adherence have used either self-report or MEMS [ 16 , 17 , 19 , 22 , 24 , 26 ]. Of the studies reviewed above, one study measured adherence using pharmacy refill record [ 18 ] and another used plasma ART concentrations [ 25 ].…”