Globally, 21% of people living with HIV are over 50 years old. Approximately 80% of people with HIV live in sub-Saharan Africa including Zimbabwe (Auterinth et al, 2016). HIV-associated neurocognitive disorders (HAND) have a prevalence of 43% globally (Wang, 2020), making it one of the biggest threats to brain health in this region. HAND consists of HIV-associated dementia, mild neurocognitive disorder, and asymptomatic neurocognitive impairment (Antinori, et al 2007). Cognitive training is effective in improving working memory, memory and executive function and could potentially also help patients with HAND (Becker et al, 2012; Ezeamama et al, 2020). The current project aims to culturally adapt and test a cognitive training intervention that can be used in adults with HAND.
This project will culturally adapt and translate a cognitive training program for adults aging with HIV. Smartbrain Pro is a computerized program with training tasks on processing speed, attention, executive function and memory that will be used to improve cognition. To ensure Smartbrain Pro works in the local Zimbabwean context, the ADAPT-ITT model of cultural adaptation will be utilized, which consists of eight sequential phases of a prescriptive method for adapting evidence-based interventions (Wingood & DiClemente, 2008). This study will be conducted at an urban clinic in Zimbabwe that offers HIV treatment services. Participants will be recruited during their routine clinic visit and will come to the clinic biweekly for cognitive training. The relevant tasks from Smartbrain Pro will be selected, culturally adapted, and translated. Twenty participants will be recruited. We anticipate qualitative results from focus group discussion with 10 participants who would have completed the intervention. This will provide feedback that can be incorporated into the intervention as it gets tested out in a future randomized control trial.
We hypothesize that Smartbrain Pro will be a robust cognitive training program to improve the brain health of adults aging with HIV. Subsequently, this will be tested in a randomized control study on cognitive rehabilitation of adults with HAND. At the conclusion of this study, we will provide a training program that can be used to improve brain health in a population with the highest prevalence of cognitive impairment globally.