Treatment Engagement Moderates the Effect of Neurocognitive Impairment on Antiretroviral Therapy Adherence in HIV-Infected Drug Users in Treatment.
Roman Shrestha, Pramila Karki, Tania B Huedo-Medina and 1 others
PMID 27769735WHAT IT FOUND
HIV patients who attended fewer behavioral treatment sessions and had more cognitive problems reported poorer adherence to antiretroviral therapy.
At higher engagement, cognitive problems were not linked to adherence.
Key findings
01Higher neurocognitive impairment was associated with lower ART adherence.
02Neurocognitive impairment was associated with lower ART adherence at low treatment engagement, but not at higher treatment engagement.
03In the regression model, treatment engagement alone was not significantly associated with ART adherence.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was 116 participants from one methadone program in New Haven, so the results may not generalize to other HIV populations or settings. ART adherence and neurocognitive impairment were self-reported, and participants may have over-reported adherence or under-reported cognitive problems. The neurocognitive measure was a brief self-report screening tool, not a comprehensive cognitive assessment. ART adherence was measured with a single visual analog scale, which may not capture complex adherence patterns. The analysis was observational: treatment engagement was attendance, not randomly assigned, so it cannot show that increasing engagement improves adherence. The study did not assess social support, depressive symptoms, or substance use disorders, which may influence the relationships.
Declared interests
The authors reported no real or perceived conflicts of interest. The article's publication types list NIH extramural research support.
The easy way to misread this
Do not conclude that increasing behavioral treatment attendance or accommodating cognitive impairment will improve ART adherence. This paper found associations in one sample, and treatment engagement was not randomly assigned, so it does not show that changing engagement causes better adherence.