Neurocognitive impairment is associated with lower health literacy among persons living with HIV infection.

This study sought to determine the effects of HIV-associated neurocognitive disorders (HAND) on health literacy, which encompasses the ability to access, understand, appraise, and apply health-related information. Participants included 56 HIV seropositive individuals, 24 of whom met Frascati criteria for HAND, and 24 seronegative subjects who were comparable on age, education, ethnicity, and oral word reading. Each participant was administered a brief battery of well-validated measures of health literacy, including the Expanded Numeracy Scale (ENS), Newest Vital Sign (NVS), Rapid Estimate of Adult Literacy in Medicine (REALM), and Brief Health Literacy Screen (BHLS). Results revealed significant omnibus differences on the ENS and NVS, which were driven by poorer performance in the HAND group. There were no significant differences on the REALM or the BHLS by HAND status. Among individuals with HAND, lower scores on the NVS were associated with greater severity of neurocognitive dysfunction (e.g., working memory and verbal fluency) and self-reported dependence in activities of daily living. These preliminary findings suggest that HAND hinders both fundamental (i.e., basic knowledge, such as numeracy) and critical (i.e., comprehension and application of healthcare information) health literacy capacities, and therefore may be an important factor in the prevalence of health illiteracy. Health literacy-focused intervention may play an important role in the treatment and health trajectories among persons living with HIV infection

Clinical Study Preliminary Evidence for Feasibility, Use, and Acceptability of Individualized Texting for Adherence Building for Antiretroviral Adherence and Substance Use Assessment among HIV-Infected Methamphetamine Users

The feasibility, use, and acceptability of text messages to track methamphetamine use and promote antiretroviral treatment (ART) adherence among HIV-infected methamphetamine users was examined. From an ongoing randomized controlled trial, 30-day text response rates of participants assigned to the intervention (individualized texting for adherence building (iTAB), n = 20) were compared to those in the active comparison condition (n = 9). Both groups received daily texts assessing methamphetamine use, and the iTAB group additionally received personalized daily ART adherence reminder texts. Response rate for methamphetamine use texts was 72.9% with methamphetamine use endorsed 14.7% of the time. Text-derived methamphetamine use data was correlated with data from a structured substance use interview covering the same time period ( < 0.05). The iTAB group responded to 69.0% of adherence reminder texts; among those responses, 81.8% endorsed taking ART medication. Standardized feedback questionnaire responses indicated little difficulty with the texts, satisfaction with the study, and beliefs that future text-based interventions would be helpful. Moreover, most participants believed the intervention reduced methamphetamine use and improved adherence. Qualitative feedback regarding the intervention was positive. Future studies will refine and improve iTAB for optimal acceptability and efficacy. This trial is registered with ClinicalTrials.gov NCT01317277

Preliminary Evidence for Feasibility, Use, and Acceptability of Individualized Texting for Adherence Building for Antiretroviral Adherence and Substance Use Assessment among HIV-Infected Methamphetamine Users

The feasibility, use, and acceptability of text messages to track methamphetamine use and promote antiretroviral treatment (ART) adherence among HIV-infected methamphetamine users was examined. From an ongoing randomized controlled trial, 30-day text response rates of participants assigned to the intervention (individualized texting for adherence building (iTAB), n = 20) were compared to those in the active comparison condition (n = 9). Both groups received daily texts assessing methamphetamine use, and the iTAB group additionally received personalized daily ART adherence reminder texts. Response rate for methamphetamine use texts was 72.9% with methamphetamine use endorsed 14.7% of the time. Text-derived methamphetamine use data was correlated with data from a structured substance use interview covering the same time period (P < 0.05). The iTAB group responded to 69.0% of adherence reminder texts; among those responses, 81.8% endorsed taking ART medication. Standardized feedback questionnaire responses indicated little difficulty with the texts, satisfaction with the study, and beliefs that future text-based interventions would be helpful. Moreover, most participants believed the intervention reduced methamphetamine use and improved adherence. Qualitative feedback regarding the intervention was positive. Future studies will refine and improve iTAB for optimal acceptability and efficacy. This trial is registered with ClinicalTrials.gov NCT01317277

Elicitation of broadly protective sarbecovirus immunity by receptor-binding domain nanoparticle vaccines

Understanding vaccine-elicited protection against SARS-CoV-2 variants and other sarbecoviruses is key for guiding public health policies. We show that a clinical stage multivalent SARS-CoV-2 spike receptor-binding domain nanoparticle vaccine (RBD-NP) protects mice from SARS-CoV-2 challenge after a single immunization, indicating a potential dose-sparing strategy. We benchmarked serum neutralizing activity elicited by RBD-NP in non-human primates against a lead prefusion-stabilized SARS-CoV-2 spike (HexaPro) using a panel of circulating mutants. Polyclonal antibodies elicited by both vaccines are similarly resilient to many RBD residue substitutions tested although mutations at and surrounding position 484 have negative consequences for neutralization. Mosaic and cocktail nanoparticle immunogens displaying multiple sarbecovirus RBDs elicit broad neutralizing activity in mice and protect mice against SARS-CoV challenge even in the absence of SARS-CoV RBD in the vaccine. This study provides proof of principle that multivalent sarbecovirus RBD-NPs induce heterotypic protection and motivates advancing such broadly protective sarbecovirus vaccines to the clinic

A Metacognition-Based Approach to Improve HIV-associated Neurocognitive Disorders among Substance Users

Rationale: The neurotoxic effects of comorbid HIV infection and substance use disorders (HIV/SUD) preferentially impact the fronto-striatal regions of the brain, leading to increased disruption of higher-order executive functions. Poor insight into such neurocognitive deficits (impaired metacognition) tracks with executive dysfunction and is associated with errors in everyday life. We evaluated the efficacy of a brief Metacognitive Training module for neurorehabilitation of HIV/SUD individuals.Design: A between-subjects, randomized design was used to examine the effectiveness of Metacognitive Training among HIV/SUD individuals with current executive dysfunction. To determine the efficacy of the Metacognitive Training compared to an executive strategy (Goal Management Training, GMT), 90 HIV/SUD participants were randomized to: 1) active control (n=30); 2) executive strategy only (i.e., GMT; n=30); or 3) Metacognitive Training plus executive strategy (Meta+GMT; n=30). Following the study condition, participants completed a complex instrumental activities of daily living (IADL) task (Everyday Multitasking Test, “Everyday MT”); additionally, in-vivo metacognitive abilities regarding IADL task performance were evaluated. Results: There was an increasing tendency for better Everyday MT performances across study conditions (Control≤GMT≤Meta+GMT) that approached significance (ps&lt;0.08). Pairwise differences indicated the GMT or Meta+GMT trainings demonstrated small (d=0.20-0.24) benefits in Everyday MT performance compared to the control condition (ps&lt;0.11). HIV/SUD individuals who completed the GMT (in addition to the Meta or not) had significant, medium-sized enhancements in Everyday MT performances compared the control condition (ps&lt;0.05; ds=0.38-0.41); the effect of these enhancements became even larger among those who had poorer dual-tasking capacities prior to training and completed the GMT (ps&lt;0.04; ds=0.83-1.04). Regarding metacognition, although there was no significant study group effect on Global Metacognition, Online Awareness (one of the two components of global abilities) showed a significant positive trend across training condition (Control≤GMT≤Meta+GMT; p=0.04). Among the skills comprising Online Awareness, a tendency toward more elaborate Task Appraisals was observed among HIV/SUD individuals who completed either the GMT or Meta+GMT (versus control; ps&lt;0.07, ds=0.21-0.27). Those who completed the GMT (in addition to the Meta or alone) demonstrated medium, significant benefits of GMT on Task Appraisals compared to the control condition (p=0.01; d=0.50).Conclusions: Our experimental design demonstrated meaningful benefits of a brief GMT executive strategy for everyday multitasking and metacognition among HIV/SUD individuals. Ours are among the first findings supporting a compensatory neurorehabilitation tool in HIV+ individuals and/or substance users