Implementing Brain Health Assessment into the HIV Care Continuum in Washington DC

Marjorie G-L
September 14, 2021

Marjorie C. Gondré-Lewis, PhD (HU) has received a National Institutes of Health CFAR Administrative Supplement grant entitled, “Implementing Brain Health Assessment into the HIV Care Continuum in Washington DC”

HIV pathogenesis has persistent, detrimental effects on the central nervous system (CNS). It is estimated that even in the era of combination antiretroviral therapy (ART), greater than 50% of persons with HIV (PWH) develop CNS involvement during the course of the disease. State-of-the-art, accessible approaches like brain magnetic resonance imaging (MRI) testing are proven sensitive tools for detecting HIV-mediated brain pathology. Together with assessments for varying severities of HIV-associated Neurocognitive Disorders (HAND) and mental health disorders, the brain health assessments (BHA) package will prove highly beneficial in identifying and treating brain disease in PWH.  Although neurocognitive impairment is a prevalent comorbidity in PWH, BHA evidence-based practices (EBPs) are not routinely applied in the treatment of HIV – especially in underserved or African American communities, and for older adults or individuals with substance use disorder (SUD) who may be vulnerable to cognitive decline.  Testing the feasibility of implementing these EBPs into the HIV care continuum and their eventual adoption in clinical settings will lead to more comprehensive assessment of neurological and neuropsychiatric complications, enhance adherence to ART, and lead to more effective treatment of co-morbidities in PWH.  This intervention aligns with national and Washington DC priorities of ‘Ending the HIV Epidemic’ (EHE) - the ‘Treatment’ pillar. The proposed work is in support of the DC Department of Health’s aim for 95% of people on treatment to achieve viral suppression by 2030, which will be thwarted if co-morbidities are not effectively managed and if PWH are resistant to ART adherence. Therefore, effective treatment must consider multiple factors including the individual pathology and health mosaic of individuals living with HIV.  We will utilize implementation science principles and strategies to understand barriers and facilitators to implementing BHA into routine care.  We will 1) Evaluate how to modify internal (within the practice) and external procedures (governing forces) that impede diagnosis and treatment of Brain Health in PWH, and 2) Engage HIV providers in DC to implement Brain Health Assessments in caring for PWH.