INS NYC 2024 Program

Poster	Poster Session 09 Program Schedule 02/16/2024 03:30 pm - 04:45 pm Room: Shubert Complex (Posters 1-60) Poster Session 09: Epilepsy \| Oncology \| MS \| Infectious Disease Final Abstract #12 Assessing Real-World Medication Adherence in People Living with HIV in the Era of One-Pill Regimens: The Role of Cognition, Self-Report, and Performance-Based Assessments Sajda Adam, Drexel University, Philadelphia, United States Will Dampier, Drexel University, Philadelphia, United States Shinika Tillman, Drexel University, Philadelphia, United States Kim Malone, Drexel University, Philadelphia, United States Vanessa Pirrone, Drexel University, Philadelphia, United States Michael Nonnemacher, Drexel University, Philadelphia, United States Amy Althoff, Drexel University, Philadelphia, United States Zsofia Szep, University of Pennsylvania, Philadelphia, United States Brian Wigdahl, Drexel University, Philadelphia, United States Maria Schultheis, Drexel University, Philadelphia, United States Kathryn Devlin, Drexel University, Philadelphia, United States Category: Infectious Disease (HIV/COVID/Hepatitis/Viruses) Keyword 1: antiretroviral treatment Keyword 2: HIV/AIDS Keyword 3: self-report Objective: Medication adherence is critical for health in people living with HIV (PWH). As the HIV epidemic evolves with advances in antiretroviral therapy, there is an ongoing need to determine the best ways to identify people at risk of adherence problems, particularly with the introduction of one-pill-a-day regimens. This study investigates the relationships among neuropsychological functioning, medication management performance, self-reported adherence, and viral load in people living with HIV. We hypothesize that cognitive impairment, particularly in attention/working memory, executive function, and episodic memory, will negatively influence medication management and virologic control, and that Medication Management Test-Revised (MMT-R) performance will better predict virologic control than self-report. Participants and Methods: Participants in this cross-sectional study were 70 adult PWH (ages 30-77, 78.6% Black) receiving combination antiretroviral therapy (cART) and enrolled in the Temple/Drexel Comprehensive NeuroHIV Center (CNHC) Clinical and Translational Research Support Core (CTRSC) cohort. Participants completed neuropsychological assessments, the Medication Management Test-Revised (MMT-R), the AIDS Clinical Trails Group (ACTG) Adherence Questionnaire, and blood sample collection. Pearson correlations examined cognitive domains in relation to MMT-R performance, and examined cognition, MMT-R, and self-reported adherence in relation to viral load. Results: 66.7% of participants had undetectable HIV RNA (<40 copies/ml). Among participants with detectable RNA, all but one had low-level viral replication (<1000 copies/ml). 87% were prescribed one-pill-a-day regimens. Verbal memory (r=.38, p=.001), executive function (r=.36, p=.002), motor function (r=.36, p=.004), processing speed (r=.26, p=.031), and working memory (r=.35, p=.003), but not visuospatial memory or verbal fluency, were positively associated with MMT-R. Neither cognition nor total MMT-R scores were significant predictors of detectable vs. undetectable RNA. When examining viral load as a continuous variable, working memory was significantly associated with log viral load (r=-.26, p=.050), and one aspect of MMT-R, items related to filling a pillbox (r =-.242, p=.069), showed a trend for being associated with log viral load. Self-reported adherence was not associated with detectable vs. undetectable viral load (r=-.113, p=.407) or log viral load (r=-.131, p=.335). Conclusions: Multiple cognitive domains were related to better MMT-R performance, but only working memory was associated with viral load. Although total MMT-R scores did not predict viral load, the pillbox domain of the MMT-R showed a trend for being a predictor for real-world virologic control and provided a more objective measure of adherence than self-report. Most participants take one pill a day, reducing the chance of cognitive difficulties affecting adherence. In this context, assessing certain aspects of adherence (e.g., filling a pillbox) appears to be more important than assessing other aspects of adherence (e.g., arithmetic) that were more relevant during the era of more complex regimens. Future research will further explore relationships among cognition, MMT-R, RNA, and regimen complexity in larger samples to inform the development of tools to monitor adherence difficulties.

Poster

02/16/2024
03:30 pm - 04:45 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease

Final Abstract #12

Assessing Real-World Medication Adherence in People Living with HIV in the Era of One-Pill Regimens: The Role of Cognition, Self-Report, and Performance-Based Assessments

Sajda Adam, Drexel University, Philadelphia, United States
Will Dampier, Drexel University, Philadelphia, United States
Shinika Tillman, Drexel University, Philadelphia, United States
Kim Malone, Drexel University, Philadelphia, United States
Vanessa Pirrone, Drexel University, Philadelphia, United States
Michael Nonnemacher, Drexel University, Philadelphia, United States
Amy Althoff, Drexel University, Philadelphia, United States
Zsofia Szep, University of Pennsylvania, Philadelphia, United States
Brian Wigdahl, Drexel University, Philadelphia, United States
Maria Schultheis, Drexel University, Philadelphia, United States
Kathryn Devlin, Drexel University, Philadelphia, United States

Category: Infectious Disease (HIV/COVID/Hepatitis/Viruses)

Keyword 1: antiretroviral treatment
Keyword 2: HIV/AIDS
Keyword 3: self-report

Objective:

Medication adherence is critical for health in people living with HIV (PWH). As the HIV epidemic evolves with advances in antiretroviral therapy, there is an ongoing need to determine the best ways to identify people at risk of adherence problems, particularly with the introduction of one-pill-a-day regimens. This study investigates the relationships among neuropsychological functioning, medication management performance, self-reported adherence, and viral load in people living with HIV. We hypothesize that cognitive impairment, particularly in attention/working memory, executive function, and episodic memory, will negatively influence medication management and virologic control, and that Medication Management Test-Revised (MMT-R) performance will better predict virologic control than self-report.

Participants and Methods:

Participants in this cross-sectional study were 70 adult PWH (ages 30-77, 78.6% Black) receiving combination antiretroviral therapy (cART) and enrolled in the Temple/Drexel Comprehensive NeuroHIV Center (CNHC) Clinical and Translational Research Support Core (CTRSC) cohort. Participants completed neuropsychological assessments, the Medication Management Test-Revised (MMT-R), the AIDS Clinical Trails Group (ACTG) Adherence Questionnaire, and blood sample collection. Pearson correlations examined cognitive domains in relation to MMT-R performance, and examined cognition, MMT-R, and self-reported adherence in relation to viral load.

Results:

66.7% of participants had undetectable HIV RNA (<40 copies/ml). Among participants with detectable RNA, all but one had low-level viral replication (<1000 copies/ml). 87% were prescribed one-pill-a-day regimens. Verbal memory (r=.38, p=.001), executive function (r=.36, p=.002), motor function (r=.36, p=.004), processing speed (r=.26, p=.031), and working memory (r=.35, p=.003), but not visuospatial memory or verbal fluency, were positively associated with MMT-R. Neither cognition nor total MMT-R scores were significant predictors of detectable vs. undetectable RNA. When examining viral load as a continuous variable, working memory was significantly associated with log viral load (r=-.26, p=.050), and one aspect of MMT-R, items related to filling a pillbox (r =-.242, p=.069), showed a trend for being associated with log viral load. Self-reported adherence was not associated with detectable vs. undetectable viral load (r=-.113, p=.407) or log viral load (r=-.131, p=.335).

Conclusions:

Multiple cognitive domains were related to better MMT-R performance, but only working memory was associated with viral load. Although total MMT-R scores did not predict viral load, the pillbox domain of the MMT-R showed a trend for being a predictor for real-world virologic control and provided a more objective measure of adherence than self-report. Most participants take one pill a day, reducing the chance of cognitive difficulties affecting adherence. In this context, assessing certain aspects of adherence (e.g., filling a pillbox) appears to be more important than assessing other aspects of adherence (e.g., arithmetic) that were more relevant during the era of more complex regimens. Future research will further explore relationships among cognition, MMT-R, RNA, and regimen complexity in larger samples to inform the development of tools to monitor adherence difficulties.