Efficacy of a Home-based Neurocognitive Remediation Program in Adults with HIV

Humphrey, Shameka C.

Shameka Humphrey^†*, Pariya Fazeli^‡*, & David Vance^†*

^†University of Alabama at Birmingham, School of Nursing

^‡University of California at San Diego

*UAB Center for Palliative Care and the AIM Program

Purpose: Despite the life-sustaining effects of Combination Antiretroviral Therapy (cART), adults with HIV continue to experience neurocognitive impairments. In fact, over half of adults with HIV experience HIV-Associated Neurocognitive Disorders (HAND). As neurocognitive impairments continue to emerge among adults with HIV, more private settings such as the home may facilitate greater use of neurocognitive remediation therapies such as speed of processing training to enhance neurocognitive and everyday functioning. The efficacy of a home-based speed of processing training was examined in middle-aged and older adults with HIV (i.e., age 40+).

Methods: In this pre-post experimental design, fifteen middle-aged and older adults with HIV received a neurocognitive battery and instructions to complete a 10-hr speed of processing training at their homes. Six weeks after initiation of training, participants received a neurocognitive posttest and a survey about their training experience and any observed cognitive gains.

Results: Higher (t(14) = 2.80, p = .01, d = 0.44) Useful Field of View (UFOV^®) scores post-training indicated significant improvement in speed of processing and executive function. There was a significant improvement on the Timed TIADL Test (t(14) = 2.14, p = .05, d = 0.22). Survey responses (1 = not at all, 3 = moderately, 5 = extremely) indicated, on average, participants liked the training moderately (M = 3.69; SD = 1.03) and observed cognitive improvements in the following domains: memory (M = 3.54; SD = 1.05), speed of processing (M = 3.77; SD = 0.83), and attention (M = 4.08; SD = 0.76).

Conclusions: Home-based speed of processing training has neuroprotective value and can be used to accommodate adults who lack accessibility to neurocognitive remediation therapies and those facing stigma who prefer to receive training in a more private setting.

Nursing Implications: Nurses are in a unique position to distribute this home-based neurocognitive program and teach their patients about alternate methods for preserving neurocognitive function. It is possible that an increasing number of adults with HIV may seek healthcare services if they are aware of more discrete options.