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Cognitive functioning, depression, and HIV medication adherence in India: a randomized pilot trial.

Ryan Cook1, Drenna Waldrop-Valverde2, Aman Sharma3

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Summary

Group cognitive-behavioral interventions improved antiretroviral therapy (ART) adherence in people living with HIV in India. Depression, but not cognitive impairment, negatively impacted adherence outcomes, highlighting the need for integrated mental health support.

Keywords:
HIVIndiaadherencecognitive functioningdepression

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Area of Science:

  • Public Health
  • Neuroscience
  • Behavioral Science

Background:

  • India has the third-highest global burden of HIV.
  • Antiretroviral therapy (ART) is available but adherence remains a challenge.
  • Cognitive impairment and depression may hinder ART adherence and intervention effectiveness.

Purpose of the Study:

  • To evaluate a group medication adherence intervention (MAI) for individuals new to ART in India.
  • To assess the impact of cognitive impairment and depression on intervention response.
  • To determine the effectiveness of behavioral interventions for improving ART adherence in the Indian context.

Main Methods:

  • 80 participants new to ART were randomized to MAI or enhanced standard of care.
  • MAI involved monthly group cognitive-behavioral sessions.
  • Adherence was measured by pill count; cognitive function and depression were assessed at baseline.

Main Results:

  • MAI participants showed a modest improvement in ART adherence compared to the control group.
  • High prevalence of cognitive impairment (57%) and depression (25%) was observed.
  • Depression, not cognitive impairment, significantly reduced intervention benefits for adherence.

Conclusions:

  • Group behavioral interventions show promise for improving ART adherence in Indian populations, including those with cognitive impairment.
  • Depression poses a significant barrier to ART adherence and intervention success.
  • Future research should focus on identifying and treating depression in people living with HIV in India to optimize treatment outcomes.