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

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Abstract

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.

Resumen

Aunque esta bien establecido que personas que utilizan drogas (PWUDs, sus siglas en inglés) se caracterizan significativamente por un deterioro neurocognitivo (NCI, sus siglas en inglés), no se h an encontrado pruebas de cómo el deterioro neurocognitivo puede impidir la habilidady sus beneficios de prevenir el VIH o de otra manera su intervención eficaz. Este trabajo incorpora la teoría, información-motivación-habilidades conductuales del modelo de salud y cambio de comportamiento (IMB, sus siglas en inglés) para examinar la influencia del NCI en VIH y sus resultados en la prevención del mismo como se define en el modelo original. El análisis incluye 304 individuos VIH negativo dependientes de opioides inscritos en un tratamiento de mantenimiento con metadona basado en la comunidad que reportaron comportamientos de riesgo a VIH por uso de drogas y/o sexo en los pasados 6 meses. Los análisis revelaron efectos de interacción entre NCI y la información para reducir el riesgo de VIH que predijosu influencia en la reducción de los comportamientos de riesgo de contraer VIH resultando en ser significativamente debilitada en función de la severidad de NCI. Los resultados apoyan el uso del modelo IMB para examinar la influencia del deterioro neurocognitivo en la reducción de conductas de riesgo para contraer el VIH y para informar futuras intervenciones dirigidas a PWUDs.

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Acknowledgments

Funding to support the study was provided by a National Institute on Drug Abuse (NIDA) Grants (R01-DA022122; K02DA033139) to Michael M. Copenhaver. NIDA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

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Authors and Affiliations

  1. Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA

    Tania B. Huedo-Medina & Michael Copenhaver

  2. Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA

    Tania B. Huedo-Medina, Roman Shrestha & Michael Copenhaver

  3. Department of Community Medicine & Health Care, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA

    Roman Shrestha

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  1. Tania B. Huedo-Medina
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Correspondence to Michael Copenhaver.

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Huedo-Medina, T.B., Shrestha, R. & Copenhaver, M. Modeling a Theory-Based Approach to Examine the Influence of Neurocognitive Impairment on HIV Risk Reduction Behaviors Among Drug Users in Treatment. AIDS Behav 20, 1646–1657 (2016). https://doi.org/10.1007/s10461-016-1394-x

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