Is “incidental finding” the best term?: a study of patients’ preferences

There is debate within the genetics community about the optimal term to describe genetic variants unrelated to the test indication, but potentially important for health. Given the lack of consensus and the importance of adopting terminology that promotes effective clinical communication, we sought the opinion of clinical genetics patients

Neuropsychological tests associated with symptomatic HIV-associated neurocognitive disorder (HAND) in a cohort of older adults in Tanzania

\ua9 The Author(s), 2024. Published by Cambridge University Press on behalf of International Neuropsychological Society.Objective: Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) prevalence is expected to increase in East Africa as treatment coverage increases, survival improves, and this population ages. This study aimed to better understand the current cognitive phenotype of this newly emergent population of older combination antiretroviral therapy (cART)-treated people living with HIV (PLWH), in which current screening measures lack accuracy. This will facilitate the refinement of HAND cognitive screening tools for this setting. Method: This is a secondary analysis of 253 PLWH aged ≥50 years receiving standard government HIV clinic follow-up in Kilimanjaro, Tanzania. They were evaluated with a detailed locally normed low-literacy neuropsychological battery annually on three occasions and a consensus panel diagnosis of HAND by Frascati criteria based on clinical evaluation and collateral history. Results: Tests of verbal learning and memory, categorical verbal fluency, visual memory, and visuoconstruction had an area under the receiver operating characteristic curve >0.7 for symptomatic HAND (s-HAND) (0.70-0.72; p < 0.001 for all tests). Tests of visual memory, verbal learning with delayed recall and recognition memory, psychomotor speed, language comprehension, and categorical verbal fluency were independently associated with s-HAND in a logistic mixed effects model (p < 0.01 for all). Neuropsychological impairments varied by educational background. Conclusions: A broad range of cognitive domains are affected in older, well-controlled, East African PLWH, including those not captured in widely used screening measures. It is possible that educational background affects the observed cognitive impairments in this setting. Future screening measures for similar populations should consider assessment of visual memory, verbal learning, language comprehension, and executive and motor function

Effectiveness of a Brief Negotiational Intervention and Text-Based Booster to Reduce Harmful and Hazardous Alcohol Use in the Emergency Department of a Low-Resource Setting: A Pragmatic Randomized Adaptive Clinical Trial in Moshi, Tanzania

Background: Alcohol use contributes to over 3 million deaths annually. In Tanzania, similar to other low- and middle-income countries, there are no evidence-based culturally adapted interventions to address harmful alcohol use behaviors. We aim to determine the effectiveness of a culturally adapted brief intervention, “Punguza Pombe Kwa Afya Yako/Reduce Alcohol for your Health”, with mobile health-based boosters in reducing alcohol use and consequences at 3 months after discharge for adult acute injury patients presenting for care. Methods: We are conducting a pragmatic adaptive randomized control trial with two distinct stages, of which we are reporting only Stage 1. Stage 1 is a superiority trial comparing a culturally adapted brief intervention with short-message-service (SMS) text boosters versus usual care. Participants eligible for enrollment are adult injury patients (≥18 years of age), who sought care for an acute injury (<24 hours) at the Kilimanjaro Christian Medical Centre Emergency Department. Alcohol-related criteria for inclusion comprise self-disclosed alcohol use prior to the injury, scoring ≥8 on the Alcohol Use Disorder Identification Test (AUDIT), and/or testing positive (>0.0 g/dL) by alcohol breathalyzer. For all stages, the primary outcome was the number of binge drinking days in the previous 4 weeks. Results: During the trial period, 448 patients met inclusion criteria and consented to participate in the study. Of these, 148 were randomized to usual care, and 300 were randomized to the intervention arms. At the 3-month follow-up, significant differences were observed between the intervention arm and the usual care group. In the primary outcome, the intervention arm showed a notable reduction in mean predicted binge drinking days by 2.03 days (95% CI: -3.53 to -0.86; p=0.0035). Additionally, significant reductions were seen in secondary outcomes for the intervention group: the mean predicted number of drinking days (reduction of 1 day; 95% CI: -2.71 to 0.82; p=0.0005), and the predicted mean difference in the number of drinks (-12.22 drinks; 95% CI: -29.5 to 3.32; p=0.0024). However, no significant differences were found between the two groups in terms of drinking-related consequences or depression. Discussion: When compared to the usual care arm, Punguza Pombe Kwa Afya Yako with text booster significantly reduces binge drinking days, binge drinking episodes, and mean number of drinks consumed. These reductions in alcohol use at 3-month follow-up suggest our culturally adapted intervention is effective for alcohol harm reduction in acute injury patients in Tanzania

Using the ADAPT guidance to culturally adapt a brief intervention to reduce alcohol use among injury patients in Tanzania

Background Harmful alcohol use is a leading risk factor for injury-related death and disability in low- and middle-income countries (LMICs). Brief negotiational interventions (BNIs) administered in emergency departments (EDs) to injury patients with alcohol use disorders (AUDs) are effective in reducing post-hospital alcohol intake and re-injury rates. However, most BNIs to date have been developed and implemented in high-income countries. The effectiveness of BNIs in LMICs is largely unknown as few studies have undertaken the rigorous task of culturally adapting these interventions to new settings. Given the high prevalence of alcohol-related injury in the Kilimanjaro region of Tanzania, we culturally adapted a BNI to reduce post-injury alcohol use for implementation in this patient population. Methods Following the ADAPT guidance, we used an iterative, multiphase process to culturally adapt a high-income country BNI to the Tanzanian context. Our team consisted of local healthcare professionals with vast experience in counseling patients and an international team of academic and clinical professionals to integrate our extensive mixed-methods patient data to adapt this intervention. Design group discussions were used to discuss research results, interpret findings, discuss the goals of the intervention, and identify and suggest areas of adaptation of the intervention as well as specific adaptations to the BNI protocol. Objective assessments of our BNI protocol as well as a BNI assessment scale was developed to guide intervention fidelity. Results We developed the Punguza Pombe Kwa Afya Yako (PPKAY); a one-time, 15-minute nurse-led BNI that encourages safe alcohol use and motivates change in alcohol use behaviors among injury patients in the Kilimanjaro region of Tanzania. Adaptations to the original intervention protocol include changes regarding the interventionist, how a patient is greeted, how the topic of alcohol use is raised, how a patient is informed of their harmful alcohol use, how graphics are visualized within the intervention protocol, how behavior change is motivated, and which behavior changes are encouraged. Similarly, we developed a BNI assessment scale to accompany the PPKAY which evaluates adherence to the protocol and motivational interviewing tenants. Conclusions The PPKAY intervention is the first alcohol BNI which was culturally adapted for delivery to injury patients in an African ED. Our study demonstrates our approach to adapting substance use interventions for use in low resource settings and shows that cultural adaptation of alcohol use interventions is feasible, beneficial and empowering for our team. Our study lays a framework and method for other low resourced settings to integrate cultural adaptation into the implementation of a BNI in low resource EDs

Is “incidental finding” the best term?: a study of patients’ preferences

PURPOSE: There is debate within the genetics community about the optimal term to describe genetic variants unrelated to the test indication, but potentially important for health. Given the lack of consensus and the importance of adopting terminology that promotes effective clinical communication, we sought the opinion of clinical genetics patients. METHODS: Surveys and focus groups with two patient populations were conducted. Eighty-eight survey participants were asked to rank four terms according to how well each describes results unrelated to the test indication: incidental findings, secondary findings, additional findings, and ancillary findings. Participants in six focus groups were guided through a free-thought exercise to describe desired attributes of such a term, and then asked to formulate a best term to represent this concept. RESULTS: The term additional findings had the most first choice rankings by survey participants, followed by secondary findings, incidental findings, and ancillary findings. Most focus group participants preferred the term additional findings; they also described reasons why other terms were not optimal. CONCLUSION: Additional findings was preferred as both more neutral and accessible than other terms currently in use. Patient perceptions and comprehension will be framed by the terminology. Thus, patient opinions should be considered by medical genetics professionals