The Impact of Neuropsychological Functioning on Adherence to HAART in HIV-Infected Substance Abuse Patients

Abstract

This study assessed the frequency of neuropsychological impairment and its relationship to adherence in a sample of HIV-infected injection drug users (IDUs) in treatment. One hundred eight participants recruited between September 2006 and October 2008 completed psychodiagnostic and neuropsychological assessments and monitored HAART adherence over a 2-week period via the use of Medication Event Monitoring System (MEMS) electronic pill caps and self-report. Assessment of concurrent functioning included clinician-rated scales of depression and substance use severity, and a battery of neuropsychological tests. Findings from individual neuropsychological tests were converted to Z scores relative to standard norms and averaged to form a composite score (NPZ). NPZ was generally poor (mean ¼ À1.505, standard deviation ¼ 1.120), with 76.9% of the sample being classified as highly impaired. Self-reported adherence was significantly higher than MEMS cap adherence. In contrast with previous studies, overall neuropsychological functioning was not a significant predictor of electronically monitored or self-reported adherence. However, examiner-rated current global severity of substance use and delayed word list recall emerged as significant predictors of self-reported adherence. Additionally, estimated premorbid verbal intelligence emerged as a significant predictor of the discrepancy between electronically monitored and self-reported adherence. Given the extent of neuropsychological impairment in this sample, future studies should examine the degree to which the impact of neuropsychological impairment may moderate interventions for this population, and the extent to which skills to cope with neuropsychological problems may boost the potential efficacy of such interventions.

Optimal Treatment Adherence Counseling Outcomes for People Living with HIV and Limited Health Literacy

“…7–8 Further complicating the relationship between literacy and health, individuals with low literacy may also have overlapping cognitive deficits that further challenge medication adherence. 9–10 Although low literacy is only one facet in a constellation of poverty indicators, studies have shown low health literacy predicts poor health, including poor ART adherence, over and above other poverty indicators including lower education. 7,11–12 For all of these reasons, it is imperative to focus on those with low health literacy in order to optimize access and adherence to ART to ultimately reduce HIV-related disparities.…”

Implementation challenges for long-acting antivirals as treatment

“…The inherent assumption in this approach is that it is the daily requirement for pills (and not the requirement to routinely attend clinic appointments), which serves as the main driver for low viral suppression rates. Examples of populations who could benefit from this prioritization scheme include adolescents [19], sex workers, or those suffering from mental illness [18,21–23,25], substance abuse [16,24,43], and housing instability [44]. However, there are other characteristics of these populations that may make them less likely to benefit from long-acting agents, such as mobility and transience.…”

“…The benefits of ART are obviously dampened in those with inadequate adherence to treatment [13,14], and failure of HIV-positive individuals to take antiretrovirals as prescribed can lead to increased transmission within a community. Multiple factors are associated with reduced adherence in the developed and developing setting, including stigma [15,16], race/ethnicity [17–20], depression [18,21,22], cognitive impairment [23], substance use [16,24], younger age [19,24,25], and adverse effects to medications [26]. Furthermore, rates of adherence to ART often decline over time [19,21,27,28], even when antiretrovirals are provided at no cost.…”

Neurocognitive Impact of Antiretroviral Treatment: Thinking Long-Term

“…Applebaum et al [74] examined the frequency and severity of neuropsychological impairment of HIV-positive injection drug users, and the extent to which the impairment impacts antiretroviral adherence. They found neuropsychological impairment among HIV-infected individuals in substance abuse treatment to be exceptionally high (76%), with the overall mean as −1.51 (SD=1.20) across all neuropsychological tests.…”