An Exploratory Factor Analysis of a Brief Self-Report Scale to Detect Neurocognitive Impairment Among Participants Enrolled in Methadone Maintenance Therapy

Occurrence of Opioid-Related Neurocognitive Symptoms Associated With Long-term Opioid Therapy

OBJECTIVE

Neurocognitive symptoms (NCSs) may be early indicators of opioid-related harm. We aimed to evaluate the incidence and potential attribution of opioid-related NCS among patients on long-term opioid therapy (LOT) by using natural language processing to extract data from the electronic health records within the Veterans Health Administration.

METHODS

We conducted a retrospective cohort study of patients prescribed LOT in 2018. NCS were identified from clinical notes across 3 periods: 6 months before LOT initiation, during LOT, and 1-year post-LOT discontinuation. Opioid-related NCS included cognitive impairment, sedation, light-headedness, altered mental status, and intoxication. We calculated incidence rates, incidence rate ratios, and hazard ratios to evaluate the occurrence and potential opioid attribution of NCS across these periods.

RESULTS

Among 55,652 patients, 3.1% experienced opioid-related NCS, with the highest incidence observed during LOT. Prevalence of NCS was greater in patients who were: between 55 and 64 (3.6%) or 65 and 74 years old (3.2%), Asian (4.8%, P = 0.02), and had received treatment for substance use disorders (7.1%, P = 0.01). In adjusted proportional hazards models, identified Asian race (hazard ratio: 2.20 [95% CI: 1.09-4.44], P = 0.03), and cooccurring conditions dementia (1.50 [1.12-2.00], 0.01), depression (1.31 [1.14-1.49], <0.01), posttraumatic stress disorder (1.18 [1.02-1.37], 0.02), substance use disorder (1.62 [1.36-1.92], 0.01), cardiovascular disease (1.18 [1.01-1.37], 0.04), chronic obstructive pulmonary disease (1.16 [1.01-1.33], 0.03), cirrhosis (1.73 [1.34-2.24], 0.01), chronic kidney disease (1.41 [1.19, 1.66]; 0.01) and traumatic brain injury (1.42 [1.06-1.91], 0.02) were associated with increased likelihood of NCS. Likelihood of NCS increased with LOT dose and decreased with LOT duration.

CONCLUSION

This study suggests that opioid-related NCS are most likely to occur during LOT, indicating a potential temporal association with opioid use. These findings highlight the importance of monitoring NCS in patients on LOT as part of a broader strategy to mitigate opioid-related harms.

Testing the feasibility, acceptability, and preliminary efficacy of integrating accommodation strategies into an HIV prevention intervention for people who inject drugs with cognitive dysfunction

BACKGROUND

Cognitive profiles of individuals with opioid use disorder (OUD) limit patients' ability to learn, retain, and recall HIV prevention information. It also limits adherence to medications, such as pre-exposure prophylaxis (PrEP). Cognitive dysfunction accommodation strategies have shown promise at reducing HIV-related risk behaviors among individuals with OUD and increasing adherence to PrEP. This study investigated the feasibility, acceptability, and preliminary efficacy of integrating accommodation strategies into a behavioral HIV prevention intervention.

METHODS

This 2-arm single blind study provided 50 people who inject drugs (PWID) with OUD linkage to PrEP services and randomized them to a 4-week HIV prevention intervention condition. The active control condition received the HIV prevention intervention as treatment per usual, while the experimental condition received the enhanced HIV prevention intervention with added accommodation strategies. Participants completed acceptability ratings of intervention content and accommodation strategies post-intervention; feasibility was measured via participant recruitment and retention. HIV risk reduction information, motivation, and behavior (IMB) assessments and HIV risk reduction skills assessments were completed pre/post-intervention. Participants also completed weekly PrEP adherence assessments.

RESULTS

The intervention content received a high acceptability rating (89 %). Intervention feasibility was deemed acceptable, with 80 % of participants completing all study protocols. The accommodation strategies integrated into the HIV prevention sessions were also endorsed by 92 % of participants. Participants in the experimental condition had significant increases in retention and recall of how to perform HIV risk reduction skills including how to properly clean a syringe (p = 0.048) and how to accurately apply a female condom (p = 0.025), compared to the control condition. Weekly PrEP adherence was reported by the three (7.5 %) participants who indicated taking PrEP throughout the study. All three participants reported missing doses throughout each of the 4 weeks.

CONCLUSIONS

Results from this study highlight the potential for integrating accommodation strategies into behavioral HIV prevention interventions to reduce the risk of HIV among PWID. Future research is needed to evaluate the use of such strategies by larger and diverse samples of PWID, as well as whether accommodation strategies enable the retention and recall of HIV prevention information and HIV prevention skills over longer periods of time.

TRIAL REGISTRATION

This trial has been retrospectively registered at ClinicalTrials.gov on June 12, 2023. (NCT05912374).

Social and cognitive determinants of medications for opioid use disorder outcomes: A systematic review using a social determinants of health framework

Disparities exist in the engagement and success of individuals seeking medications for opioid use disorder (MOUD) treatment. Existing work suggests that individual-level factors such as cognitive functioning influence MOUD treatment, less is known about the role of environmental factors beyond the individual such as social determinants of health (SDOH). The aim of this systematic review was to summarize the literature of neuropsychological assessment in the context of MOUD treatment using an SDOH framework. We included peer-reviewed articles based in the United States and published in the English language that evaluated neuropsychological assessment on MOUD treatment outcomes. Three electronic databases were searched from January 2022 to September 2023 without restricting the date of publication for article inclusion. We identified 34 empirical articles that met inclusion criteria, the majority being nonrandomized clinical trials. Few studies examined differences in neuropsychological performance over time or in response to an adjunct intervention. Findings comparing cognitive functioning across MOUD and comparisons groups were mixed, as were findings from the studies that examined changes in cognitive functioning over time. Factors represented from the SDOH framework included educational attainment, premorbid intellectual functioning, and employment status. Neuropsychological domains and type of assessments varied, as did inclusion/exclusion and demographic characteristics. Existing literature is mixed on whether neuropsychological deficits in individuals with OUD are amenable to treatment, particularly among populations disproportionally disadvantaged by SDOH. More research is needed on the SDOH and other contextual factors that influence cognitive factors and MOUD treatment engagement and success.

Latent profile analysis of data from the brief inventory of neurocognitive impairment (BINI) to develop neuro-cognitive profiles among opioid-dependent patients in drug treatment

BACKGROUND

Neurocognitive dysfunction is common among individuals with opioid use disorders (OUD) and can impede a range of treatment outcomes. We developed the 57-item Brief Inventory of Neuro-cognitive Impairment (BINI) to help detect and monitor neurocognitive dysfunction in the context of drug treatment settings. To date, no study has examined the possible presence of BINI subgroups among OUD patients, which could enhance our ability to tailor intervention strategies to meet individual treatment needs. The purpose of this study was to conduct a latent profile analysis to identify BINI subgroups that differ in terms of their reported and objective neurocognitive dysfunction. We hypothesized that subgroups would emerge, suggesting the potential benefit of implementing tailored strategies for optimal treatment outcomes.

METHODS

Latent profile analyses included data from opioid-dependent patients (N = 177) enrolled in a methadone maintenance treatment program between July 2018 and October 2019.

RESULTS

We found three profiles of self-reported neurocognitive symptoms, including those with 1) minimal concerns 2) moderate concerns, and 3) many concerns across multiple domains.

CONCLUSIONS

If these results are confirmed, the BINI may be used to rapidly identify persons who require specific accommodation strategies to improve their drug treatment outcomes.

Integrating Cognitive Dysfunction Accommodation Strategies into an HIV Prevention Session: A 2-Arm Pilot Feasibility Study

Cognitive dysfunction is prevalent among persons on medication for opioid use disorder (MOUD). This cognitive dysfunction has been shown to reduce HIV treatment engagement and medication adherence. We investigated the impact of integrating specific behavioral strategies into an HIV prevention session to accommodate cognitive dysfunction among people on MOUD. Patients on MOUD (n = 20) were randomized to one of two different HIV prevention conditions. The same HIV risk reduction content was presented to both conditions; however, the experimental condition had accommodation strategies integrated into the session. Participants completed a skills checklist at pre-, post-, and 2-week follow-up to examine the level of HIV risk reduction content learned and utilized over time. Participants in the experimental condition indicated high acceptability (95%) for the accommodation strategies. These participants also demonstrated greater improvement in the ability to properly clean a syringe, from pre- to post- (p < 0.02) and from pre- to follow-up (p < 0.02) when compared to participants in the standard condition. Results from this pilot study indicate that accommodation strategies improved participants’ ability to learn, retain, and utilize risk reduction skills over time. This foundation of research indicates a promising, innovative strategy to increase the ability for persons on MOUD to engage in HIV prevention behaviors.

Developing a cognitive dysfunction risk score for use with opioid-dependent persons in drug treatment

BACKGROUND

Cognitive dysfunction is common in persons seeking medication for opioid use disorder (MOUD) and may hinder many addiction-related services. Brief but accurate screening measures are needed to efficiently assess cognitive dysfunction in these resource-limited settings. The study aimed to develop a brief predictive risk score tailored for use among patients in drug treatment.

METHODS

The present study examined predictors of mild cognitive impairment (MCI), objectively assessed via the NIH Toolbox, among 173 patients receiving methadone as MOUD at an urban New England drug treatment facility. Predictors of MCI were identified in one subsample using demographic characteristics, medical chart data, and selected items from the Brief Inventory of Neuro-Cognitive Impairment (BINI). Predictors were cross-validated in a second subsample using logistic regression. Receiver operating curve (ROC) analyses determined an optimal cut-off score for detecting MCI.

RESULTS

A cognitive dysfunction risk score (CDRS) was calculated from patient demographics (age 50+, non-White ethnicity, less than high school education), medical and substance use chart data (history of head injury, overdose, psychiatric diagnosis, past year polysubstance use), and selected self-report items (BINI). The CDRS discriminated acceptably well, with a ROC curve area of 70.6 %, and correctly identified 78 % of MCI cases (sensitivity = 87.5 %; specificity = 55.6 %).

CONCLUSIONS

The CDRS identified patients with cognitive challenges at a level likely to impede treatment engagement and/or key outcomes. The CDRS may assist in efficiently identifying patients with cognitive dysfunction while requiring minimal training and resources. Larger validation studies are needed in other clinical settings.

Association between the brief inventory of neurocognitive impairment (BINI) and objective cognitive testing among persons with opioid use disorders in drug treatment

The current study examined the association between subjective cognitive dysfunction and objective test performance in persons enrolled in drug treatment and stabilized on methadone maintenance therapy (MMT). A total of 177 participants completed the self-reported brief inventory of neurocognitive impairment (BINI) and NIH Toolbox test battery. In participants with neurocognitive dysfunction, scores on all BINI subscales were negatively associated with objective performance on the NIH Toolbox (BINI Global r = -0.26, p = 0.01; BINI Subscales ranging -0.22 to -0.32, all p's < 0.03). Using cutoff scores, results showed participants who scored above the cutoff on the BINI Learning subscale demonstrated significant evidence of objective neurocognitive dysfunction on the NIH Toolbox (65% vs. 35%; χ2 = 6.57, p = 0.02), suggesting possible clinical utility. Future studies are needed to determine the feasibility of using the BINI to inform the accommodation of patients with specific neurocognitive profiles to optimize treatment outcomes.

Cognitive profiles in persons with opioid use disorder enrolled in methadone treatment

Cognitive impairment is common in persons with opioid use disorder and associated with poor treatment outcomes, including elevated risk for relapse. Much less is known about the underlying structure of these deficits and the possible presence of cognitive phenotypes. A total of 177 adults (average 42.2 years of age, 52.0% male, 65.5% Caucasian) enrolled in a methadone maintenance treatment program completed the NIH Toolbox as part of a larger project. Cluster analyses revealed a 2-cluster solution-persons with intact cognitive function in all domains (n = 93; Intact) and those with impairments on tests of attention and executive function (n = 83; Impaired). Follow-up analyses revealed that the Impaired group was slightly older, more likely to self-identify as a racial/ethnic minority, and less likely to report consuming alcohol four or more times per week. These findings suggest the existence of distinct cognitive profiles in persons with opioid use disorder and encourage further examination, particularly studies to examine the possible benefits of routine screening for cognitive impairment as part of substance use treatment.

Rationale and design of an integrated bio-behavioral approach to improve adherence to pre-exposure prophylaxis and HIV risk reduction among opioid-dependent people who use drugs: The CHRP-BB study

BACKGROUND

Few primary HIV prevention strategies have successfully integrated both behavioral and biomedical components, with modest HIV risk reduction outcomes among opioid-dependent people who use drugs (PWUD). In response to this unmet need, we developed a brief, bio-behavioral intervention to simultaneously promote PrEP adherence and reduce HIV risk among opioid-dependent PWUD.

METHODS

Using a Hybrid Type I implementation science design, we will examine the efficacy of the integrated bio-behavioral, Community-friendly Health Recovery Program (CHRP-BB) compared to a time-and-attention matched control condition among HIV-negative, opioid-dependent PWUD who are prescribed PrEP and enrolled in a methadone maintenance program (MMP) using a randomized controlled trial (RCT). Participants are assessed at baseline, immediately post-intervention (8 weeks) and follow-ups at weeks 20, 32, and 44 post-intervention. The primary outcome is biomedical (PrEP adherence), with secondary outcomes including behavioral (self-reported drug- and sex-related HIV risk behaviors), ongoing drug use (confirmed with urine drug testing), and related domains of the theoretical information-motivation-behavioral skills (IMB) model of behavior change related to PrEP adherence and HIV-transmission-risk reduction. Additionally, we will conduct a process evaluation of delivery/implementation of the intervention to collect valuable information to be used in future implementation.

CONCLUSIONS

This study will be among the first prospective trial to test an integrated bio-behavioral intervention to improve adherence to PrEP and HIV risk reduction among opioid-dependent PWUD.

Examining the Acceptability of mHealth Technology in HIV Prevention Among High-Risk Drug Users in Treatment

Despite promising trends of the efficacy of mobile health (mHealth) based strategies to a broad range of health conditions, very few if any studies have been done in terms of the examining the use of mHealth in HIV prevention efforts among people who use drugs in treatment. Thus, the goal of this study was to gain insight into the real-world acceptance of mHealth approaches among high-risk people who use drugs in treatment. A convenience sample of 400 HIV-negative drug users, who reported drug- and/or sex-related risk behaviors, were recruited from a methadone clinic in New Haven, Connecticut. Participants completed standardized assessments of drug- and sex-related risk behaviors, neurocognitive impairment (NCI), and measures of communication technology access and utilization, and mHealth acceptance. We found a high prevalence of current ownership and use of mobile technologies, such as cell phone (91.5%) including smartphone (63.5%). Participants used mobile technologies to communicate mostly through phone calls (M = 4.25, SD = 1.24), followed by text messages (M = 4.21, SD = 1.29). Participants expressed interest in using mHealth for medication reminders (72.3%), receive information about HIV (65.8%), and to assess drug-related (72.3%) and sex-related behaviors (64.8%). Furthermore, participants who were neurocognitively impaired were more likely to use cell phone without internet and show considerable interest in using mHealth as compared to those without NCI. The findings from this study provide empirical evidence that mHealth-based programs, specifically cell phone text messaging-based health programs, may be acceptable to this high-risk population.

An explanatory factor analysis of a brief self-report scale to detect neurocognitive impairment among HIV-positive men who have sex with men and transgender women in Peru

Neurocognitive impairment (NCI) has been associated with poor clinical outcomes in various patient populations. This study used exploratory factor analysis (EFA) to examine the factor structure of the existing 95-item Neuropsychological Impairment Scale (NIS) to create a suitable NCI screening instrument for people living with HIV (PLH). In Lima, Peru, 313 HIV-positive men who have sex with men (MSM) and transgender women (TGW) prescribed antiretroviral therapy (ART) completed the NIS using computer-assisted self-interviews (CASI). The EFA used principal axis factoring and orthogonal varimax rotation, which resulted in 42 items with an 8-factor solution that explained 51.8% of the overall variance. The revised, 8-factor, Brief Inventory of Neurocognitive Impairment for Peru (BINI-P) showed a diverse set of factors with excellent to good reliability (i.e., F1 α = 0.92 to F8 α = 0.78). This EFA supports the use of the BINI-P to screen for NCI among Spanish-speaking, HIV-positive MSM and TGW. Future research should examine the effectiveness of the BINI-P in detecting NCI in clinical care settings and the impact of NCI on HIV health-related outcomes, including linkage and retention in care, ART adherence and HIV risk behaviors.

Interest in use of mHealth technology in HIV prevention and associated factors among high-risk drug users enrolled in methadone maintenance program

The adoption of mobile technologies for health (mHealth) in healthcare has grown considerably in recent years, but systematic assessment of interest in the use of mHealth in HIV prevention efforts among people who use drugs (PWUD) is lacking. We therefore examined interest in use of mHealth technology in HIV prevention and associated individual-level factors among high-risk PWUD enrolled in methadone maintenance program. A total of 400 HIV-negative PWUD, who reported drug- and/or sex-related risk behaviors completed a standardized assessment using audio computer assisted self-interview (ACASI). Results revealed significant interest in using mHealth-based approaches for specific purposes, including: to receive medication reminders (72.3%), to receive information about HIV risk reduction (65.8%), and to assess HIV risk behaviors (76.5%). Multivariate analysis showed that interest in receiving medication reminders was associated with currently taking medication and being neurocognitively impaired, whereas interest in receiving HIV-risk reduction information was associated with being non-white, married, and perceiving the person was at high-risk for contracting HIV. Similarly, participants' interested in using mHealth for HIV risk behavior assessment was associated with having recently visited a healthcare provider and exhibiting depressive symptoms. Overall, this study demonstrated that high-risk PWUD are interested in using mHealth-based tools as a key part of an HIV prevention approach within a common type of drug treatment settings. Thus, formative research on preferences for design and functionality of mHealth-based HIV prevention tools are now needed, followed by practical development, implementation, and evaluation of these new intervention strategies.

Intent to Use Preexposure Prophylaxis (PrEP), HIV Risk Behaviors, and Self-Report Neurocognitive Symptoms by High-Risk Drug Users: A Mediation Analysis

Neurocognitive impairment (NCI) and HIV risk are significant correlates of intent to use preexposure prophylaxis (PrEP). The extent to which similar outcomes could occur when these factors operate together, particularly for people who use drugs (PWUD), remains an important unanswered question. We therefore sought evidence that HIV risk behavior mediated the relationship between NCI and intent to use PrEP in high-risk PWUD in treatment. HIV-uninfected, methadone-maintained people who reported HIV-risk behaviors were enrolled (n = 400). Variables of interest (NCI, HIV risk behaviors, intent to use PrEP) were assessed using audio computer-assisted self-interview. We found preliminary evidence of indirect effect of HIV risk behaviors, such that NCI had an increased impact on intent to use PrEP via HIV risk behaviors. As a result of having this information, clinicians and researchers will be better equipped for evidence-informed targeting and dissemination efforts to optimize PrEP uptake by this underserved population.

A Self-Report Measure to Detect Neurocognitive Impairment among Incarcerated People Living with HIV in Malaysian Context: An Exploratory Factor Analysis

While neurocognitive impairment (NCI) among people living with HIV (PLWH) who use drugs and its impact on HIV treatment outcomes continue to be widely investigated, there remains a critical gap in NCI assessment among HIV-infected people who use drugs (PWUD) in Malaysian context. The present study, therefore, sought to improve the utility of the existing Neuropsychological Impairment Scale (NIS) as a screening tool for assessing NCI by establishing its psychometric properties in the Malaysian context. The NIS is a brief, self-report measure originally designed to assess NCI by having individuals rate a range of items that may influence cognitive functioning. HIV-infected male prisoners (N=301) administered the full 95-item NIS. An exploratory factor analysis (EFA) was conducted using principal axis factoring and orthogonal varimax rotation. Reliability was measured using Cronbach's alpha. The EFA resulted in an abbreviated, psychometrically sound, eight-factor structure (54-item) revised NIS - now referred to as the Brief Inventory of Neuro-cognitive Impairment-Malaysia (BINI-M). It is better designed to detect NCI in PLWH, ranging from generalized neurocognitive symptoms to more specific forms of impairment with excellent to average reliability. The BINI-M may serve as a useful tool for clinicians and researchers to assess NCI in PLWH and can inform enhanced treatment strategies in the Malaysian context.

Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

BACKGROUND

Although people who use drugs (PWUD) are key populations recommended to receive pre-exposure prophylaxis (PrEP) to prevent HIV, few data are available to guide PrEP delivery in this underserved group. We therefore examined the willingness to initiate PrEP and the anticipation of HIV risk reduction while on PrEP among high-risk PWUD.

METHODS

In a cross-sectional study of 400 HIV-negative, opioid dependent persons enrolled in a methadone program and reporting recent risk behaviors, we examined independent correlates of being willing to initiate PrEP.

RESULTS

While only 72 (18%) were aware of PrEP, after being given a description of it, 251 (62.7%) were willing to initiate PrEP. This outcome was associated with having neurocognitive impairment (aOR=3.184, p=0.004) and higher perceived HIV risk (aOR=8.044, p<0.001). Among those willing to initiate PrEP, only 12.5% and 28.2%, respectively, indicated that they would always use condoms and not share injection equipment while on PrEP. Consistent condom use was associated with higher income (aOR=8.315, p=0.016), always using condoms with casual partners (aOR=6.597, p=0.001), and inversely associated with ongoing drug injection (aOR=0.323, p=0.027). Consistent safe injection, however, was inversely associated with age (aOR=0.948, p=0.035), ongoing drug injection (aOR=0.342, p<0.001), and perceived HIV risk (aOR=0.191, p=0.019).

CONCLUSIONS

While willingness to initiate PrEP was high and correlated with being at elevated risk for HIV, anticipated higher risk behaviors in this group even while on PrEP suggests that the next generation of HIV prevention approaches may need to combine biomedical and behavioral components to sustain HIV risk reduction over time.

The Influence of Neurocognitive Impairment, Depression, and Alcohol Use Disorders on Health-Related Quality of Life among Incarcerated, HIV-Infected, Opioid Dependent Malaysian Men: A Moderated Mediation Analysis

Prior research has widely recognized neurocognitive impairment (NCI), depression, and alcohol use disorders (AUDs) as important negative predictors of health-related quality of life (HRQoL) among people living with HIV (PLWH). No studies to date, however, have explored how these neuropsychological factors operate together and affect HRQoL. Incarcerated male PLWH (N = 301) meeting criteria for opioid dependence were recruited from Malaysia's largest prison. Standardized scales for NCI, depression, alcohol use disorders (AUDs) and HRQoL were used to conduct a moderated mediation model to explore the extent to which depression mediated the relationship between NCI, HRQoL, and AUDs using an ordinary least squares regression-based path analytic framework. Results showed that increasing levels of NCI (B = -0.1773, p < 0.001) and depression (B = -0.6147, p < 0.001) were negatively associated with HRQoL. The effect of NCI on HRQoL was significantly (Sobel z = -3.5600, p < 0.001) mediated via depression (B = -0.1230, p < 0.001). Furthermore, the conditional indirect effect of NCI on HRQoL via depression for individuals with AUDs was significant (B = -0.9099, p = 0.0087), suggesting a moderated mediation effect. The findings disentangle the complex relationship using a moderated mediation model, demonstrating that increasing levels of NCI, which can be reduced with HIV treatment, negatively influenced HRQoL via depression for individuals with AUDs. This highlights the need for future interventions to target these complex interplay between neuropsychological factors in order to improve HRQoL among PLWH, particularly incarcerated PLWH with AUDs.

Treatment Engagement Moderates the Effect of Neurocognitive Impairment on Antiretroviral Therapy Adherence in HIV-Infected Drug Users in Treatment

Neurocognitive impairment (NCI) and treatment engagement (TE) have been shown to significantly predict antiretroviral therapy (ART) adherence, but no studies have explored the ways and the extent to which similar outcomes might occur when these factors operate together, particularly for people who use drugs (PWUDs). We sought to discover whether TE moderated the effect of NCI on adherence to ART in HIV-infected individuals. One hundred sixteen HIV-infected, methadone-maintained people who reported HIV risk behaviors were enrolled in the study. Variables of interest (NCI, ART adherence, TE) were assessed using audio computer-assisted self-interview. Results revealed a significant interactive effect of NCI and TE on ART adherence, which supported the moderation effect. Findings from post hoc analyses showed that NCI was negatively associated with adherence to ART at low levels of TE. Findings suggest the need to accommodate individual NCI and improve TE as a means to enhance ART adherence in HIV-infected PWUDs.

Modeling a Theory-Based Approach to Examine the Influence of Neurocognitive Impairment on HIV Risk Reduction Behaviors Among Drug Users in Treatment

Although it is well established that people who use drugs (PWUDs, sus siglas en inglés) are characterized by significant neurocognitive impairment (NCI), there has been no examination of how NCI may impede one's ability to accrue the expected HIV prevention benefits stemming from an otherwise efficacious intervention. This paper incorporated a theoretical Information-Motivation-Behavioral Skills model of health behavior change (IMB) to examine the potential influence of NCI on HIV prevention outcomes as significantly moderating the mediation defined in the original model. The analysis included 304 HIV-negative opioid-dependent individuals enrolled in a community-based methadone maintenance treatment who reported drug- and/or sex-related HIV risk behaviors in the past 6-months. Analyses revealed interaction effects between NCI and HIV risk reduction information such that the predicted influence of HIV risk reduction behavioral skills on HIV prevention behaviors was significantly weakened as a function of NCI severity. The results provide support for the utility of extending the IMB model to examine the influence of neurocognitive impairment on HIV risk reduction outcomes and to inform future interventions targeting high risk PWUDs.