Adapting a Behavioral Intervention to Accommodate Cognitive Dysfunction in People Who Inject Drugs

Implementing Cognitive Dysfunction Accommodation Strategies Into a Biobehavioral Pre-Exposure Prophylaxis (PrEP) Focused HIV Prevention Intervention for People Who Inject Drugs

The goal of this pilot work was to determine if the cognitive dysfunction accommodation strategies help patients retain/utilize more HIV prevention information and increase PrEP adherence. Fifty people who inject drugs (PWID) were prescribed PrEP and randomized to one of two conditions, Twenty-five PWID participated in a standard HIV prevention session and 25 other PWID participated in a HIV prevention session with the included accommodation strategies. At recruitment participants were asked to provide self-report of the screening form and cognitive functioning. The intervention consisted of a total of 5 sessions: 1 meeting to gain baseline information of participants and 4 intervention sessions. Participants completed the consent form, demographics, skills assessment, drug use behavior assessment, and HIV risk behavior assessment at the pre-interview meeting. Participants completed PrEP uptake assessments and skills assessments immediately following the intervention to compare the pre/post results between the two groups. All participants also completed an acceptability rating to help researchers determine the acceptability of the accommodation strategies used, at the end of the 4th session. The objective was to determine if the proposed accommodation strategies are feasible and efficacious at improving HIV prevention outcomes, including knowledge and skills. Information gleaned from this process will be used to refine the intervention approach for future testing and implementation.

Participants will complete a 4-week CHRP-BB intervention enhanced with included cognitive dysfunction accommodation strategies.

CHRP-BB is an evidence-informed behavioral intervention for HIV prevention among high-risk drug users in treatment on PrEP. CHRP-BB consists of 4 weekly 50- minute sessions.

The enhanced version of CHRP-BB is an adapted behavioral intervention for HIV prevention among high-risk drug users in treatment on PrEP. This intervention consists of 4 weekly 50- minute sessions that include cognitive dysfunction accommodation strategies.

a 15 item checklist of HIV risk reduction skills, the lower the score the lower the ability to perform HIV risk reduction skills

a 15 item checklist of HIV risk reduction skills, the lower the score the lower the ability to perform HIV risk reduction skills

Participants completed an ten-item intervention acceptability rating, the lower the number the lower the participants acceptability of the intervention

Inclusion Criteria: at least 18 years or older reported injection drug use in the past 30 days reported engagement in drug- and/or sex- related HIV risk behaviors HIV negative are willing to initiate PrEP use can communicate (read, write and speak) in English experience mild/moderate level of cognitive dysfunction Exclusion Criteria: cannot attend all study sessions actively homicidal and/or suicidal