Cognitive screening considerations for psychosocial clinical trials in HIV, aging, and cognition.

Cognitive impairment is a common comorbidity among individuals aging with HIV, which can be an extreme source of stress and anxiety for many. Psychosocial interventions have the potential to alleviate symptoms associated with cognitive impairment and help improve the quality of life of people with HIV as they continue to age; these interventions are in the infancy of development and require further testing via clinical trials. The slow development of interventions may be partially attributed to a common trend of requiring a formal HIV-associated neurocognitive disorder diagnosis to qualify for psychosocial clinical trials. HIV-associated neurocognitive disorder is diagnosed through intensive, time-consuming tests, and still many cases of HIV-associated neurocognitive disorder remain undiagnosed, misdiagnosed, or misclassified due to the limitations of the assessment process. This commentary suggests an alternate method of screening for cognitive impairments through the use of a brief, low-barrier assessment, alongside validity considerations. Such alternate screening may improve enrollment and completion rates in psychosocial clinical trials for people aging with HIV and cognitive impairment, by removing the burden of extensive testing that is commonly associated with an HIV-associated neurocognitive disorder diagnosis from clinical trial eligibility, while still providing valuable insight into individuals' cognitive functioning.

Coronavirus disease 2019 vaccine effectiveness among a population-based cohort of people living with HIV.

OBJECTIVE: People with HIV were underrepresented in coronavirus disease 2019 (COVID-19) vaccine clinical trials. We estimated vaccine effectiveness (VE) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for the BNT162b2, mRNA-1273, and ChAdOx1 vaccines among a population-based cohort of people with HIV in Ontario, Canada. DESIGN: Test-negative design. METHODS: We identified people with HIV aged ≥19 years who were tested for SARS-CoV-2 by RT-PCR between December 14, 2020 (first availability of COVID-19 vaccines) and November 21, 2021 (pre-Omicron circulation). Outcomes included any infection, symptomatic infection, and COVID-19-related hospitalization/death. We compared the odds of vaccination between test-positive cases and test-negative controls using multivariable logistic regression with adjustment for age, sex, region, calendar time, SARS-CoV-2 test histories, influenza vaccination, comorbidities, and neighborhood-level socio-economic status. VE was derived as (1 - adjusted odds ratio) × 100%. RESULTS: Among 21 023 adults living with HIV, there were 801 (8.3%) test-positive cases and 8,879 (91.7%) test-negative controls. 20.1% cases and 47.8% of controls received ≥1 COVID-19 vaccine dose; among two-dose recipients, 93.4% received ≥1 mRNA dose. Two-dose VE ≥7 days before specimen collection was 82% (95% confidence interval [CI] = 74-87%) against any infection, 94% (95% CI = 82-98%) against symptomatic infection, and 97% (95% CI = 85-100%) against hospitalization/death. Against any infection, VE declined from 86% (95% CI = 77-92%) within 7-59 days after the second dose to 66% (95% CI = -15-90%) after ≥180 days; we did not observe evidence of waning protection for other outcomes. CONCLUSION: Two doses of COVID-19 vaccine offered substantial protection against symptomatic illness and hospitalization/death in people with HIV prior to the emergence of the Omicron variant. Our findings do not support a broad conclusion that COVID-19 VE is lower among people with HIV in populations that, for the most part, are attending HIV care, taking antiretroviral medication, and are virally suppressed.

Training Peers to Ease Hospital Discharge: A Community-Clinical Partnership in Complex HIV Care.

BACKGROUND: Since many people now live with human immunodeficiency virus (HIV) as a complex, chronic health condition that may require frequent medical and psychosocial services, a potential new role for HIV-positive peers involves support during an inpatient admission that extends past discharge to improve the transition home from hospital. We sought to begin outlining scope of peer support in complex HIV care, by detailing a training curriculum alongside experiences and recommendations by Peer Volunteers. METHODS: A community-clinical partnership designed a personalized peer intervention for people living with HIV who were acutely hospitalized and struggling with antiretroviral adherence and substance use. Five Peer Volunteers delivered the program, which involved being matched with a participant for a pre-discharge in-person meeting followed by frequent phone contact in the 7 weeks following discharge. A 4-day peer training focused on active listening, structuring a call, use of self, boundaries, and facilitating program closure. The curriculum was informed by theories of change, motivational interviewing, and simulation. Peer Volunteers participated in pre-match and post-match interviews with peer researchers (also living with HIV). Thematic analysis was employed by four independent coders to understand how prepared peers were and areas for program improvement. CONCLUSIONS: Peers verified participant feelings and affirmed their experiences, followed-up on participant goals to track progress, disclosed their own relevant experiences to build rapport, and facilitated closure to enable program success. Peers struggled maintaining an emotional connection over the phone and were concerned when participants were nonresponsive. This article discusses how the training was piloted and adapted for practice.

Protocol for a pilot randomised controlled trial evaluating feasibility and acceptability of cognitive remediation group therapy compared with mutual aid group therapy for people ageing with HIV-associated neurocognitive disorder (HAND) in Toronto, Canada.

INTRODUCTION: HIV-associated neurocognitive disorder (HAND) may affect 30%-50% of people ageing with HIV. HAND may increase stress and anxiety, and impede coping. Psychosocial group therapy may ameliorate HAND's symptoms, yet the ideal intervention is unclear. This protocol outlines a pilot randomised controlled trial (RCT)-designed using community-based participatory research-to pilot cognitive remediation group therapy (CRGT) against an active comparator. METHODS AND ANALYSIS: This is a pilot, parallel design, two-arm RCT that will recruit participants diagnosed with the mild neurocognitive disorder form of HAND from a neurobehavioural research unit at a tertiary care hospital in Toronto, Canada. Eligibility criteria include age ≥40 years, known HIV status for 5+ years, English fluency, able to consent and able to attend 8 weeks of group therapy. Eligible participants will be randomised to one of two treatment arms, each consisting of eight-session group interventions delivered once weekly at 3 hours per session. Arm 1 (novel) is CRGT, combining mindfulness-based stress reduction with brain training activities. Arm 2 (active control) is mutual aid group therapy. The primary outcomes are feasibility, measured by proportions of recruitment and completion, and acceptability, determined by a satisfaction questionnaire. The secondary outcome is intervention fidelity, where content analysis will be used to assess facilitator session reports. A between-group analysis will be conducted on exploratory outcomes of stress, anxiety, coping and use of intervention activities that will be collected at three time points. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Research Ethics Boards of St. Michael's Hospital and the University of Toronto. Findings will be disseminated through peer-reviewed publications, conference presentations and community reporting. This study could provide insight into design (eg, recruitment, measures) and intervention considerations (eg, structure, content) for a larger trial to lessen the burden of cognitive decline among people ageing with HIV. TRIAL REGISTRATION NUMBER: NCT03483740; Pre-results.

The ART of conversation: feasibility and acceptability of a pilot peer intervention to help transition complex HIV-positive people from hospital to community.

OBJECTIVES: To pilot a peer-based intervention for people living with HIV who used substances, had challenges with antiretroviral adherence and would be discharged from hospital to community. STUDY DESIGN: A community-based, quasi-experimental pilot intervention study designed to assess feasibility, acceptability and connection to a community-based HIV organisation. SETTING: This study was conducted in Toronto, Canada, at Casey House (CH; hospital for people living with HIV) in collaboration with the AIDS Committee of Toronto (ACT; community-based HIV organisation). PARTICIPANTS: People living with HIV who were CH inpatient between 1 April 2017 and 31 March 2018, struggled with antiretroviral adherence, actively used substances and would be discharged to community were eligible. Forty people met criteria, 19 were approached by an inpatient nurse and 17 consented. Average age was 48.8 years (SD=11.4), 58.8% were male and participants averaged 7.8 physical and mental health comorbidities (SD=3.1). INTERVENTION: Titled 'The ART of Conversation', the three-pronged personalised intervention was developed through input from CH clients and ACT volunteers, all living with HIV. Intervention components were (a) predischarge goal-setting (adherence, substance use and self-identified goal) with the study nurse; (b) predischarge meeting with an HIV+ peer volunteer (PV) and (c) nine postdischarge phone calls between PV and participant, once per day for 3 days, then once per week for 6 weeks. PRIMARY OUTCOMES: Feasibility was measured through proportion of eligible participants recruited and PV availability. Acceptability was assessed through participant interviews at three times (preintervention, post-intervention and 6 weeks follow-up) and through PV call logs. Client records determined connection to ACT within the study timeframe. RESULTS: Twelve participants completed the intervention and nine connected with ACT. Predischarge goal-setting and PV meeting were both feasible and acceptable. Postdischarge phone calls were a challenge as half of completers missed at least one call. CONCLUSIONS: Although predischarge goal-setting and PV meeting were feasible, methods to maintain connection following discharge require further investigation.

Assessment of anxiety among Northern Plains Indians.

This study is an examination of the reliability and validity of the Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988) in a sample of NPIs (N = 529). Validity was assessed by comparing BAI scores among 3 different diagnostic categories in a clinical sample (anxiety disorder, mood disorder, and comorbid anxiety/mood disorder diagnostic groups) and a community sample of participants with no self-reported mental health diagnoses. The BAI was also compared with depression, quality of life, and anxiety measures to assess validity. Support toward the validity of the BAI was demonstrated through high correlations with similar measures of anxiety, as well as higher scores among the clinical samples compared to the control sample. The BAI also demonstrated strong internal consistency (α = .95). An exploratory factor analysis indicated the presence of 3 factors: (a) fear, (b) cardiorespiratory, and (c) body instability symptoms. The BAI was unable to accurately differentiate between mood disorder and anxiety disorder groups. Results of this study indicate that the BAI may be a useful instrument in the assessment of anxiety with NPIs; however, the BAI is potentially unsuited to differentiating between mood disorders and anxiety disorders with this population. (PsycINFO Database Record

Does Irish-dance training influence lower-limb asymmetry?

Irish-dance is a dance form where asymmetry is required. This study investigated the influence of Irish-dance training on four lower-limb asymmetries by comparing 100 Irish-dancers and 100 non-dancers. All four asymmetries showed significant differences between the dancers and the non-dancers: the rigidity of the dance training influencing those asymmetries.

A survey of sidedness in Northern Irish schoolchildren: the interaction of sex, age, and task.

The study examined lateral preference in use of hands, feet, eyes, and ears in a group of nearly 5000 schoolchildren in Northern Ireland. Performance tests were carried out by student teachers during their school-based work in 2002 and data were submitted on-line. Six tasks were used-writing, throwing a ball, kicking a ball, hopping, listening to quiet sounds, and looking through a cardboard tube. There was right bias in every task but the extent of it differed between tasks. Males were generally less right biased than females, and younger children less than older ones; for hearing, the changes with age were markedly different in the two sexes, with females showing a strong increase in right bias but males showing none. These observational results do little to illuminate the reasons for the patterns observed.

Kissing laterality and handedness.

Kissing behaviour was observed between kissing couples: about 80% turned their heads to the right to kiss. To remove the influence of one kissing partner upon the other, kissing behaviour was also observed between participants and a symmetrical doll's face: about 77% turned their heads to the right to kiss. There was no significant difference in handedness between right- and left-kissers: both groups were predominantly right-kissers. It is thought that motor bias rather than emotive bias influences kissing behaviour.

The anti-nuclease humoral immune response of broiler chickens exposed to Staphylococcus aureus, infectious bursal disease virus and chicken anaemia virus in an experimental model for bacterial chondronecrosis and osteomyelitis.

This study aimed to develop an enzyme-linked immunosorbent assay to detect antibody associated with Staphylococcus aureus that is produced during the chicken immune response to this organism. The protein nuclease was tested for suitability as an antigen to detect antibody in sera from broiler chickens that had been exposed to aerosolized S. aureus on day 1 post hatch during experiments to reproduce bacterial chondronecrosis and osteomyelitis. An enzyme-linked immunosorbent assay was developed to measure the levels of nuclease antibody in 509 chicken sera from various experiments, which also enabled the examination of the influence of factors such as the S. aureus infection status and co-infection with chicken anaemia virus (CAV) and infectious bursal disease virus (IBDV) on nuclease antibody levels. Positive levels of nuclease antibody were detected in 71% of serum samples from chickens inoculated with S. aureus, CAV and IBDV, while positive levels were detected in 35% of chickens inoculated with S. aureus only. The influence of CAV and IBDV on the number of chickens with positive levels was most prominent in chickens aged up to 42 days. The study showed that nuclease-specific antibodies form part of the humoral immune response in broiler chickens that have been exposed to S. aureus. Co-infection with CAV and IBDV appeared to promote development of antibody in birds younger than 42 days; however, the presence of antibody did not necessarily prevent systemic infection.