Purpose:Disparities in cognition among middle-aged and older African American/Black adults are evident, especially among people living with HIV (PLWH). Though disparities in health literacy among African American/Black adults impact health outcomes across clinical populations, its role in racial differences in cognition among PLWH is not well understood. This study aimed to determine if health literacy mediated racial differences in cognition among PLWH and people living without HIV (PLWoH). Patients and methods:Measures of oral word literacy (Wide Range Achievement Test-3rd Edition), health literacy (Test of Functional Literacy in Adults - Reading Comprehension subtest, Rapid Estimate of Adult Literacy in Medicine, Newest Vital Sign, Expanded Numeracy Scale), and cognition (gold standard neurocognitive battery) were examined in 273 participants (170 PLWH: 86% African American/Black; 103 PLWoH: 65% African American/Black) via secondary analysis. Multivariable linear regressions (MLRs) among PLWH and PLWoH examined associations between health literacy and cognition, accounting for relevant covariates, followed by adjusted bootstrap confidence interval mediation analyses to determine whether health literacy mediated the association between race and cognition. Results:In both samples, White people scored higher than African American/Black people on measures of cognition, health literacy, oral word literacy, and SES. Adjusted MLRs in PLWH and PLWoH separately showed health literacy was associated with cognition (PLWH: b = .205, p = .007; PLWoH: b = 0.354, p = .002). Health literacy significantly mediated the association between race and cognition, independent of covariates (PLWH: effect = .055, 95% CI [0.0048, 0.1973]; PLWoH: effect = .093, 95% CI [0.0276, 0.1827]). Conclusion:These results underscore the importance of health literacy in explaining racial disparities in cognition among African American/Black PLWH and PLWoH in the Deep South. Findings have implications for guiding the development of health literacy interventions, which may have downstream positive impacts on cognition.
Purpose:Despite evidence that: 1) older people living with HIV (PLHIV) experience a high burden of stress that is associated with myriad poorer outcomes, 2) psychological resilience may buffer the negative effects of stress in older PLHIV, and 3) older PLHIV may possess lower levels of this protective factor than seronegative counterparts, little work has examined strategies to bolster resilience in older PLHIV. This article details the protocol for a pilot clinical trial examining the feasibility and efficacy of a theory-driven resilience intervention that has been adapted for older PLHIV. Patients and Methods:This study plans to randomize 100 older PLHIV aged 45+ with suboptimal HIV treatment management to either an intervention condition (i.e., Resilience Intervention for Successful Aging Enhancement [RISE+]) or an attention-matched control condition. Both arms include weekly one-hour in person group intervention sessions. The comprehensive assessment includes proximal mechanistic measures, (i.e., real-time measurement of resilience resources and stress reactivity and recovery via experience sampling method [ESM] text message-prompted online surveys) and health (i.e., psychological functioning and HIV outcomes) measures. Primary Aims focus on intervention effects on: the use of resilience resources and whether such increases drive improved affective stress reactivity and recovery (Aim 1) and distal health outcomes at three months (Aim 2). Conclusions:This study tests a novel resilience intervention among older PLHIV and has several strengths, including focusing on an at-risk and understudied population, rigorous examination of efficacy and mechanism, and utilizing an intervention with minimal facilitator involvement, which has implications for future scalability. Findings will identify intervention mechanisms and inform the development of potent and scalable interventions for building resilience in older PLHIV and other diverse populations of older adults.
Background and Purpose:Cognitive intra-individual variability (IIV) refers to the fluctuations observed in cognitive performance. The aim of this article was to characterize and describe for illustrative purposes an approach to administer executive functioning training to people living with HIV (PLWH) to reduce their cognitive IIV. This brief report highlights four cases in an on-going study investigating cognitive IIV in HIV. In HIV, cognitive IIV has been associated with cognitive decline, cortical atrophy, and mortality risk. The Executive Dysfunction Hypothesis suggests improving executive functioning could reduce cognitive IIV. Study Design:In the parent on-going pilot RCT (called the Executive Functioning Training (EFT) Study), 120 PLWH are randomized to either a no-contact control group or an executive functioning training group which receives 20 hours of computerized exercises. To characterize this study, this article describes an interim descriptive case analysis (N=4) that was conducted with the first two participants who completed training (n=2) and compared to demographically-matched control (n=2) participants. Results:Using the Connor's Continuous Performance Test 3rd Edition, results showed improvements in reaction time (Hit RT, by -24.5 points) and cognitive IIV (HRT SD, Variability, by -16 points) in the training group compared to the no-contact control group. In other words, the training appeared to reduce cognitive IIV. Conclusion:This finding suggests that by improving executive functioning through executive functioning training, this may stabilize cognitive functioning in general, as indicated by reduced cognitive IIV. Although preliminary, these encouraging results support the Executive Dysfunction Hypothesis and suggests further exploration of cognitive IIV may provide insights on how to improve cognition in aging PLWH. Implications for neuroscience nursing are provided.
Background:Consistent adherence to prescribed hypertension treatment regimens is an important goal for persons living with hypertension, yet it remains a challenge for minority and underserved populations. Employing technology-based intervention (TBI) to support self-managing hypertension presents an opportunity to effectively control BP, and potentially have long-term effects on health outcomes. Objective:The objective of this study is to test the efficacy of a TBI, OPtimizing Technology to Improve Medication Adherence and BP Control (OPTIMA-BP), as an approach to support hypertension self-management to improve BP, health-related quality of life (HRQOL), and long-term compliance in African Americans with hypertension. Methods:This prospective, 2-arm randomized trial conducted in the Midwest will enroll African American older adults with hypertension, 50 years of age and older, recruited from primary clinics and community settings. Participants are allocated in a 1:1 ratio using computer-generated randomization to OPTIMA-BP intervention (n = 104) or Waitlist control group (n = 104). Participants are asked to participate in the study over a 12-month period and complete 5 study visits. Individuals in the OPTIMA-BP intervention group will receive three technology components (web-based education, medication adherence mHealth app, study provided home BP monitor), coupled with nurse counselling and communication to providers for guideline-directed treatment regimen. We will also collect data on knowledge-attitude mechanisms of self-management (hypertension knowledge, self-efficacy, perceived social support) and proximal behavioral mechanisms (antihypertension medication-taking, diet, exercise). Qualitative analyses will explore participants' experiences with self-managing hypertension using technology. Results:Participant recruitment began in March 2022, and is currently ongoing. It is anticipated that preliminary findings appropriate for analysis will be disseminated Summer 2025. The primary endpoint is a change in BP (<130/80 mmHg) and improved HRQOL. Conclusion:Using TBI along with standard preventive measures provides a unique opportunity to improve BP control and enhance secondary CVD prevention in this high-risk group. Trial Registration:ClinicalTrials.gov NCT05564728; https://clinicaltrials.gov/study/NCT05564728.
Background and Purpose:Cognitive training programs have been attempted to improve cognition in cognitively vulnerable people living with HIV (PLWH). Some have attempted to improve episodic memory or speed of processing, while others have used an individualized cognitive domain approach targeting each person's cognitive deficits. Although effective, none of these approaches considered the influence of cognitive intra-individual variability (IIV). Cognitive IIV refers to the fluctuations in one's individual cognitive ability across cognitive domains (dispersion) or within the same test (inconsistency). Greater cognitive IIV predicts cognitive decline as well as decreased cognitive integrity and increased neuropathology. Some neuroscientists posited that poor executive functioning, known as the Executive Dyscontrol Hypothesis, increases cognitive IIV. Thus, if we can improve executive functioning, we may be able to decrease cognitive IIV and improve overall cognitive functioning. This article provides the rationale and protocol for a feasibility clinical trial examining an executive functioning training intervention in middle-aged and older PLWH. Study Design:This study utilizes a two-arm baseline/posttest experimental design to examine the primary aim 1 (feasibility and acceptability) and the exploratory aim 1 (cognition) in 120 community-dwelling PLWH aged 40 and older. Participants will be randomized into one of the two arms: 1) 20 hours of computerized executive functioning training group, or 2) a no-contact control group. The proposed training time is 10 to 12 weeks (1 to 2 one-hour training sessions/week, while working around participants' schedules). At baseline and posttest, participants will receive a 1.5 to 2-hour assessment that includes many measures including the Connor's Continuous Performance Test (Version 3), and a 50-minute self-administered computerized cognitive performance battery (BRACE+ = BrainBaseline Assessment of Cognition and Everyday Functioning). Conclusion:This study tests an innovative intervention designed to reduce cognitive IIV; to our knowledge, no other study has targeted cognitive IIV as an intervention outcome.
