A Focus on Aging, HIV/AIDS, and Neurocognitive Challenges: Examining Southern Nevada HIV Sector Providers’ Awareness and Prospective Roles
Abstract
:1. Introduction
2. Materials and Methods
2.1. Partnerships and Collaborations
2.2. Participants
2.3. Procedures and Material
2.4. Analysis of Data
3. Results
3.1. Provider Awareness and Knowledge
3.1.1. Prior Knowledge and Current Awareness
“Well, I know there’s such a thing as HIV dementia. I’ve had a number of older clients who I know would fall into that category [based on what I’ve learned in the past from reading about it]. You know, most of them are without a diagnosis, so it’s very difficult to say for sure. I have a number of clients who appear to have issues related to memory, and just cognition, in general.”
3.1.2. Lived Experiences of Patients and Clients with Neurocognitive Challenges
“I’ll literally be working with someone, and I had to help them understand that, yes, they got their HIV care, but I’m like, oh my goodness, they’re not even paying attention to their care provider anymore. Their brain and their focus was literally withering away. I was re-explaining to them, ‘You’re going to a doctor for your HIV care, but they’re not your neurologist or psychiatrist.’ They were having difficulty paying attention and understanding that they needed to see another healthcare provider for their brain health issues.”
“I have two clients right now that called me five times already today. So they have definite memory issues and are just struggling to put the pieces together. We have one client who has a problematic situation, and they’re contacting different case managers across the city. I realize that they forget that they’ve already sought help and received it. What ends up happening, stuff gets complicated because they keep, you know, going in circles asking more and more people for help, and we don’t know that they’ve already asked for help from other people. So I give them advice to resolve their situation, not knowing somebody else is giving them a different piece of advice, and then they get confused and think that people are trying to trick them.”
“I had to basically walk them through in detail the paperwork and different steps needed so that they could access their social security benefits. I was able to experience that on a one-on-one basis, and I think they had like an education level of 3rd grade to begin with. Over time, I was able to see their cognitive function decline as they kept going on without getting medication.”
3.1.3. Lack of Knowledge as a Barrier to Providing Needed Care
“I think, the biggest thing is just getting the information out there. That this is a problem that PLWH are facing, and could later be facing. I think a lot of the clients that I meet [minimize it and] attribute their challenges to age, and have made flippant comments like, ‘Oh, at this age, I have to write everything down’… not knowing that it could be an effect of living with HIV for so long.”
“If they’re not aware, not educated, and if it’s not talked about, this can lead to their deteriorating health mentally and physically. It’s basically a lot of lack of knowledge, and it’s not discussed, you know. We need more provider education so that we could offer more education to clients.”
“[Even] a primary care doctor [who does not specialize in HIV/AIDS] may not even recognize that certain symptoms are related to their patient’s HIV/AIDS because they haven’t necessarily been educated [about HAND]. ‘Cause I don’t think there’s a lot of people out there that know that part. So it’s the education of professionals and providers more than, you know, the people that are in the HIV community.”
3.1.4. Continuing Education and Professional Development
“Well, um, in the job that I do, I am constantly training. There’s constant training and continuing education. So I’ve attended hundreds of seminars, and that’s often brought up this topic. I think all providers should have regular training so they are able to help their clients better.”
“A lot of the ongoing information that we received is about, you know, new medications or new forms of treatment delivery, which we get from the actual drug companies themselves. They would send representatives to talk about their drugs. Getting some sort of resource on brain health would be really beneficial for us. Not only how to watch out for symptoms or perhaps even how to identify HAND, but also how to best address its impacts and what practical resources are out there for our clients to utilize.”
3.2. Prospective Provider Roles
3.2.1. Early Detection
“I’m not a medical doctor, so I always try to encourage clients to talk to their physicians or see a health specialist within our community, especially when I notice something odd or different with the clients. The challenge at times, is a client has to acknowledge that there’s something going on. You know, some people, especially if they’re estranged from their families or friends, and they’re alone, it’s challenging for them to admit that they may be losing their independence or may require [professional] help from someone. So sometimes, it’s down to us to find creative ways to get them more help.”
“For example, at a doctor’s appointment for someone [with neurocognitive challenges] newly diagnosed or maybe trying to get back in care, there could be a case manager, patient advocate, or some provider who can help with bringing the client to someone who screens for different cognitive disorders. That person could be there with them, at least until a care plan is set in place.”
3.2.2. Direct and Practical Support
“A lot of it is food assistance, housing assistance, and emergency financial assistance for things like bills and utilities. Some are mental health programs or educational programs, things like lunch and learns, and group education events. With some patience and compassion from us, our programs and services could help our clients cope with concerns and problems they may have resulting from their brain health issues.”
“I am in charge of health education, the risk reduction to our clients who are virally suppressed, as well as creating new and exciting workshops that combat negative emotions and provide psychosocial support. Through these different programs, we’re able to help older folks with cognitive problems.”
3.2.3. Appropriate and Timely Referrals
4. Discussion
Strengths and Limitations of the Study
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Gandhi, R.T.; Bedimo, R.; Hoy, J.H.; Landovitz, R.J.; Smith, D.M.; Eaton, E.F.; Lehmann, C.; Springer, S.A.; Sax, P.E.; Thompson, M.A.; et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2022 recommendations of the International Antiviral Society–USA panel. J. Am. Med. Assoc. 2023, 329, 63–84. [Google Scholar] [CrossRef]
- Mutchler, M.G.; Wagner, G.; Cowgill, B.O.; McKay, T.; Risley, B.; Bogart, L.M. Improving HIV/AIDS care through treatment advocacy: Going beyond client education to empowerment by facilitating client–provider relationships. AIDS Care 2011, 23, 79–90. [Google Scholar] [CrossRef] [PubMed]
- WebMD Editorial Contributors. How to Treat HIV. Available online: https://www.webmd.com/hiv-aids/understanding-aids-hiv-treatment. (accessed on 21 September 2023).
- Alford, K.; Daley, S.; Banerjee, S.; Vera, J.H. Quality of life in people living with HIV—Associated neurocognitive disorder: A scoping review study. PLoS ONE 2021, 16, e0251944. [Google Scholar] [CrossRef]
- Buckley, S.; Byrnes, S.; Cochrane, C.; Roche, M.; Estes, J.D.; Salemidis, S.; Angelovich, T.A.; Churchill, M.J. The role of oxidative stress in HIV-associated neurocognitive disorders. Brain Behav. Immun. Health 2021, 13, 100235. [Google Scholar] [CrossRef] [PubMed]
- Liboro, R.M.; Rourke, S.B.; Ibañez-Carrasco, F.; Eaton, A.; Pugh, D.; Medina, C.; Rae, A.; Shuper, P.A.; Ross, L.E. Strategies employed by community-based service providers to address HIV-associated neurocognitive challenges: A qualitative study. J. Int. Assoc. Provid. AIDS Care 2019, 18, 1–8. [Google Scholar] [CrossRef] [PubMed]
- Liboro, R.M.; Ibañez-Carrasco, F.; Rourke, S.B.; Eaton, A.; Medina, C.; Pugh, D.; Rae, A.; Ross, L.E.; Shuper, P.A. Barriers to addressing HIV-associated neurocognitive disorder (HAND): Community-based service provider perspectives. J. HIV/AIDS Soc. Serv. 2018, 17, 209–223. [Google Scholar] [CrossRef]
- Wei, J.; Hou, J.; Su, B.; Jiang, T.; Guo, C.; Wang, W.; Zhang, Y.; Chang, B.; Wu, H.; Zhang, T. The prevalence of Frascati-criteria-based HIV-associated neurocognitive disorder (HAND) in HIV-infected adults: A systematic review and meta-analysis. Front. Neurol. 2020, 11, 581346. [Google Scholar] [CrossRef]
- Robertson, K.R.; Smurzynski, M.; Parsons, T.D.; Wu, K.; Bosch, R.J.; Wu, J.; McArthur, J.; Collier, A.; Evans, S.; Ellis, R.J. The prevalence and incidence of neurocognitive impairment in the HAART era. AIDS 2007, 21, 1915–1921. [Google Scholar] [CrossRef]
- Gouse, H.; Masson, C.J.; Henry, M.; Marcotte, T.D.; London, L.; Kew, G.; Rourke, S.; Robbins, R.N. Assessing HIV provider knowledge, screening practices, and training needs for HIV-associated neurocognitive disorders. A short report. AIDS Care 2021, 33, 468–472. [Google Scholar] [CrossRef]
- Clifford, D.B.; Ances, B.M. HIV-associated neurocognitive disorder. Lancet Infect. Dis. 2013, 13, 976–986. [Google Scholar] [CrossRef]
- Grant, I. Neurocognitive disturbances in HIV. Int. Rev. Psychiatry 2008, 20, 33–47. [Google Scholar] [CrossRef]
- Vastag, Z.; Fira-Mladinescu, O.; Rosca, E.C. HIV-associated neurocognitive disorder (HAND): Obstacles to early neuropsychological diagnosis. Int. J. Gen. Med. 2022, 15, 4079–4090. [Google Scholar] [CrossRef] [PubMed]
- Simioni, S.; Cavassini, M.; Annoni, J.M.; Abraham, A.R.; Bourquin, I.; Schiffer, V.; Calmy, A.; Chave, J.; Giacobini, E.; Hirschel, B.; et al. Cognitive dysfunction in HIV patients despite long-standing suppression of viremia. AIDS 2010, 24, 1243–1250. [Google Scholar] [CrossRef] [PubMed]
- Rosenthal, J.; Tyor, W. Aging, comorbidities, and the importance of finding biomarkers for HIV-associated neurocognitive disorders. J. Neurovirol. 2019, 25, 673–685. [Google Scholar] [CrossRef] [PubMed]
- Heaton, R.K.; Marcotte, T.D.; Rivera-Mindt, M.; Sadek, J.; Moore, D.J.; Bentley, H.; McCutchan, J.A.; Reicks, C.; Grant, I.; HNRC Group. The impact of HIV-associated neuropsychological impairment on everyday functioning. J. Int. Neuropsychol. Soc. 2004, 10, 317–331. [Google Scholar] [CrossRef] [PubMed]
- Zenebe, Y.; Necho, M.; Yimam, W.; Akele, B. Worldwide occurrence of HIV-associated neurocognitive disorders and its associated factors: A systematic review and meta-analysis. Front. Psychiatry 2022, 13, 814362. [Google Scholar] [CrossRef]
- Irollo, E.; Luchetta, J.; Ho, C.; Nash, B.; Meucci, O. Mechanisms of neuronal dysfunction in HIV-associated neurocognitive disorders. Cell. Mol. Life Sci. 2021, 78, 4283–4303. [Google Scholar] [CrossRef]
- Johnson, T.; Nath, A. Biotypes of HIV-associated neurocognitive disorders based on viral and immune pathogenesis. Curr. Opin. Infect. Dis. 2022, 35, 223–230. [Google Scholar] [CrossRef]
- Carey, C.L.; Woods, S.P.; Gonzalez, R.; Conover, E.; Marcotte, T.D.; Grant, I.; Heaton, R.K. Predictive validity of global deficit scores in detecting neuropsychological impairment in HIV infection. J. Clin. Exp. Neuropsychol. 2004, 26, 307–319. [Google Scholar] [CrossRef]
- Woods, S.P.; Rippeth, J.D.; Frol, A.B.; Levy, J.K.; Ryan, E.; Soukup, V.M.; Hinkin, C.H.; Lazzaretto, D.; Cherner, M.; Marcotte, T.D.; et al. Interrater reliability of clinical ratings and neurocognitive diagnoses in HIV. J. Clin. Exp. Neuropsychol. 2004, 26, 759–778. [Google Scholar] [CrossRef]
- Cysique, L.A.; Rourke, S.B. Neurocognitive Complications of HIV Infection: Neuropathogenesis to Implications for Clinical Practice; Springer: Cham, Switzerland, 2021. [Google Scholar] [CrossRef]
- Mastrorosa, I.; Pinnetti, C.; Brita, A.C.; Mondi, A.; Lorenzini, P.; Del Duca, G.; Vergori, A.; Mazzotta, V.; Gagliardini, R.; Camici, M.; et al. Declining prevalence of human immunodeficiency virus (HIV)–associated neurocognitive disorders in recent years and associated factors in a large cohort of antiretroviral therapy–treated individuals with HIV. Clin. Infect. Dis. 2023, 76, e629–e637. [Google Scholar] [CrossRef] [PubMed]
- Wang, Y.; Liu, M.; Lu, Q.; Farrell, M.; Lappin, J.M.; Shi, J.; Lu, L.; Bao, Y. Global prevalence and burden of HIV-associated neurocognitive disorder: A meta-analysis. Neurol. 2020, 95, e2610–e2621. [Google Scholar] [CrossRef] [PubMed]
- Rosca, E.C.; Albarqouni, L.; Simu, M. Montreal cognitive assessment (MoCA) for HIV-associated neurocognitive disorders. Neuropsychol. Rev. 2019, 29, 313–327. [Google Scholar] [CrossRef] [PubMed]
- Rosca, E.C.; Tadger, P.; Cornea, A.; Tudor, R.; Oancea, C.; Simu, M. International HIV dementia scale for HIV-associated neurocognitive disorders: A systematic review and meta-analysis. Diagnostics 2021, 11, 1124. [Google Scholar] [CrossRef]
- Matchanova, A.; Woods, S.P.; Kordovski, V.M. Operationalizing and evaluating the Frascati criteria for functional decline in diagnosing HIV-associated neurocognitive disorders in adults. J. Neurovirol. 2020, 26, 155–167. [Google Scholar] [CrossRef]
- Meyer, A.L. Need to revise Frascati criteria for HIV-associated neurocognitive disorders to improve relevance for diverse global populations. Neurol. Clin. Pract. 2022, 12, 328–330. [Google Scholar] [CrossRef]
- AIDSVu. Local Data: Las Vegas. 2022. Available online: https://aidsvu.org/local-data/united-states/west/nevada/las-vegas/ (accessed on 21 September 2023).
- Creswell, J.W.; Plano Clark, V.L. Designing and Conducting Mixed Methods Research, 3rd ed.; Sage: Thousand Oaks, CA, USA, 2018; pp. 173–208. [Google Scholar]
- Coughlin, S.S. Community-based participatory research studies on HIV/AIDS prevention, 2005–2014. Jacobs J. Community Med. 2016, 2, 1–26. [Google Scholar]
- Rhodes, S.D.; Malow, R.M.; Jolly, C. Community-based participatory research: A new and not-so-new approach to HIV/AIDS prevention, care, and treatment. AIDS Educ. Prev. 2010, 22, 173–183. [Google Scholar] [CrossRef]
- Wallerstein, N.B.; Duran, B. Using community-based participatory research to address health disparities. Health Promot. Pract. 2006, 7, 312–323. [Google Scholar] [CrossRef]
- Palys, T. Purposive sampling. In The SAGE Encyclopedia of Qualitative Research Methods; Given, L.M., Ed.; Sage: Thousand Oaks, CA, USA, 2008; Volume 2, pp. 697–698. [Google Scholar] [CrossRef]
- Ranuschio, B.; Waldron, J.; Barnes, L.; Bell, S.; Puno, T.; Despres, J.; Sedere, A.; Sheik Yosef, N.; Villalobos, E.; Wackens, J.; et al. Awareness and Knowledge of Aging and HIV-Associated Neurocognitive Disorder: Service User and Provider Perspectives in Southern Nevada; Community Report; CHAMPION Mental Health Lab, University of Nevada: Nevada, LA, USA, 2022. [Google Scholar] [CrossRef]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef]
- Morgan, E.E.; Woods, S.P.; Iudicello, J.E.; Grant, I.; Villalobos, J. Poor self-efficacy for healthcare provider interactions among individuals with HIV-associated neurocognitive disorders. J. Clin. Psychol. Med. Settings 2019, 26, 13–24. [Google Scholar] [CrossRef]
- Woods, S.P.; Iudicello, J.E.; Morgan, E.E.; Cameron, M.V.; Doyle, K.L.; Smith, T.V.; Cushman, C. Health-related everyday functioning in the internet age: HIV-associated neurocognitive disorders disrupt online pharmacy and health chart navigation skills. Arch. Clin. Neuropsychol. 2016, 31, 176–185. [Google Scholar] [CrossRef]
- Bougea, A.; Spantideas, N.; Galanis, P.; Gkekas, G.; Thomaides, T. Optimal treatment of HIV-associated neurocognitive disorders: Myths and reality. A critical review. Ther. Adv. Infect. Dis. 2019, 6, 1–19. [Google Scholar] [CrossRef]
- Alford, K.; Banerjee, S.; Nixon, E.; O’Brien, C.; Pounds, O.; Butler, A.; Elphick, C.; Henshaw, P.; Anderson, S.; Vera, J.H. Assessment and management of HIV-associated cognitive impairment: Experience from a multidisciplinary memory service for people living with HIV. Brain Sci. 2019, 9, 37. [Google Scholar] [CrossRef]
- Belete, T.; Medfu, G.; Yemiyamrew, E. Prevalence of HIV associated neurocognitive deficit among HIV positive people in Ethiopia: A cross sectional study at Ayder referral hospital. Ethiop. J. Health Sci. 2017, 27, 67–76. [Google Scholar] [CrossRef]
- Ng, R.Q.; Yip, K.F.; Teh, Y.E. An overview of neurocognitive impairment in older people living with HIV. Proc. Singap. Healthc. 2023, 32, 1–10. [Google Scholar] [CrossRef]
- Tsegaw, M.; Andargie, G.; Alem, G.; Tareke, M. Screening HIV-associated neurocognitive disorders (HAND) among HIV positive patients attending antiretroviral therapy in South Wollo, Ethiopia. J. Psychiatr. Res. 2017, 85, 37–41. [Google Scholar] [CrossRef]
- Justice, A.C.; Chang, C.H.; Rabeneck, L.; Zackin, R. Clinical importance of provider-reported HIV symptoms compared with patient-report. Med. Care 2001, 39, 397–408. [Google Scholar] [CrossRef]
- Centers for Disease Control and Prevention. Social Determinants of Health at CDC. 2022. Available online: https://www.cdc.gov/about/sdoh/index.html (accessed on 2 August 2023).
- World Health Organization. Social Determinants of Health. n.d. Available online: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 (accessed on 2 August 2023).
- Muhammad, J.N.; Fernandez, J.R.; Clay, O.J.; Saag, M.S.; Overton, E.T.; Willig, A.L. Associations of food insecurity and psychosocial measures with diet quality in adults aging with HIV. AIDS Care 2019, 31, 554–562. [Google Scholar] [CrossRef]
- Logie, C.H.; Sokolovic, N.; Kazemi, M.; Islam, S.; Frank, P.; Gormley, R.; Kaida, A.; Pokomandy, A.; Loutfy, M.; CHIWOS Research Team. Does resource insecurity drive HIV-related stigma? Associations between food and housing insecurity with HIV-related stigma in cohort of women living with HIV in Canada. J. Int. AIDS Soc. 2022, 25, e25913. [Google Scholar] [CrossRef]
- Surratt, H.L.; O’Grady, C.L.; Levi-Minzi, M.A.; Kurtz, S.P. Medication adherence challenges among HIV positive substance abusers: The role of food and housing insecurity. AIDS Care 2015, 27, 307–314. [Google Scholar] [CrossRef] [PubMed]
- Kiplagat, J.; Mwangi, A.; Chasela, C.; Huschke, S. Challenges with seeking HIV care services: Perspectives of older adults infected with HIV in western Kenya. BMC Public Health 2019, 19, 929. [Google Scholar] [CrossRef]
- Schatz, E.; Knight, L.; Mukumbang, F.C.; Teti, M.; Myroniuk, T.W. ‘You have to withstand that because you have come for what you have come for’: Barriers and facilitators to antiretroviral treatment access among older South Africans living with HIV. Sociol. Health Illn. 2021, 43, 624–641. [Google Scholar] [CrossRef] [PubMed]
- Dawson-Rose, C.; Cuca, Y.P.; Webel, A.R.; Báez, S.S.S.; Holzemer, W.L.; Rivero-Méndez, M.; Eller, L.S.; Reid, P.; Johnson, M.O.; Kemppainen, J.; et al. Building trust and relationships between patients and providers: An essential complement to health literacy in HIV care. J. Assoc. Nurses AIDS Care 2016, 27, 574–584. [Google Scholar] [CrossRef] [PubMed]
- Magnus, M.; Herwehe, J.; Murtaza-Rossini, M.; Reine, P.; Cuffie, D.; Gruber, D.; Kaiser, M. Linking and retaining HIV patients in care: The importance of provider attitudes and behaviors. AIDS Patient Care STDs 2013, 27, 297–303. [Google Scholar] [CrossRef] [PubMed]
- Tobias, C.; Cunningham, W.E.; Cunningham, C.O.; Pounds, M.B. Making the connection: The importance of engagement and retention in HIV medical care. AIDS Patient Care STDs 2007, 21, S-3–S-8. [Google Scholar] [CrossRef]
- O’Brien, N.; Hong, Q.N.; Law, S.; Massoud, S.; Carter, A.; Kaida, A.; Loutfy, M.; Cox, J.; Andersson, N.; de Pokomandy, A. Health system features that enhance access to comprehensive primary care for women living with HIV in high-income settings: A systematic mixed studies review. AIDS Patient Care STDs 2018, 32, 129–148. [Google Scholar] [CrossRef]
- Edelman, E.J.; Cole, C.A.; Richardson, W.; Boshnack, N.; Jenkins, H.; Rosenthal, M.S. Opportunities for improving partner notification for HIV: Results from a community-based participatory research study. AIDS Behav. 2014, 18, 1888–1897. [Google Scholar] [CrossRef]
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Ranuschio, B.; Bell, S.; Flatt, J.D.; Barnes, L.; Puno, T.; Ribeiro, A.; Sheik-Yosef, N.; Villalobos, E.; Wackens, J.; Liboro, R.M. A Focus on Aging, HIV/AIDS, and Neurocognitive Challenges: Examining Southern Nevada HIV Sector Providers’ Awareness and Prospective Roles. Int. J. Environ. Res. Public Health 2023, 20, 6876. https://doi.org/10.3390/ijerph20196876
Ranuschio B, Bell S, Flatt JD, Barnes L, Puno T, Ribeiro A, Sheik-Yosef N, Villalobos E, Wackens J, Liboro RM. A Focus on Aging, HIV/AIDS, and Neurocognitive Challenges: Examining Southern Nevada HIV Sector Providers’ Awareness and Prospective Roles. International Journal of Environmental Research and Public Health. 2023; 20(19):6876. https://doi.org/10.3390/ijerph20196876
Chicago/Turabian StyleRanuschio, Brandon, Sherry Bell, Jason D. Flatt, Lianne Barnes, Trinity Puno, Alexander Ribeiro, Nadia Sheik-Yosef, Esmeralda Villalobos, Janelle Wackens, and Renato M. Liboro. 2023. "A Focus on Aging, HIV/AIDS, and Neurocognitive Challenges: Examining Southern Nevada HIV Sector Providers’ Awareness and Prospective Roles" International Journal of Environmental Research and Public Health 20, no. 19: 6876. https://doi.org/10.3390/ijerph20196876