Methamphetamine (MA) is one of the most commonly used illicit drugs worldwide and is a major risk factor for the transmission of HIV infection. The neurotoxic effects of comorbid MA dependence and HIV infection (MA/HIV) preferentially impact the frontostriatal regions of the brain leading to increased prevalence of HIV-associated neurocognitive disorders (HAND) that affect up to 60% of the population, particularly disrupting higher-order executive functions (e.g., problem-solving abilities). In both HIV and MA, executive dysfunction is associated with dependence in instrumental activities of daily living (IADLs;e.g., medication or financial management). Despite the high risk for and economic burden of HAND-related disability (e.g., unemployment), there are currently no empirically validated techniques to treat HAND among MA users. One cognitive rehabilitation technique that has been effective for improving IADL functioning in other populations with executive dysfunction (e.g., traumatic brain injury) is metacognitive training. Metacognition involves the capacity for introspection including accurate perception and assessment of one's everyday performance and its consequences. Metacognition is commonly impaired following brain injury to the prefrontal systems and is associated with integrity of executive functions;in fact, up to 50% of HIV individuals show poor insight into their cognitive abilities, which is directly associated with poorer IADL outcomes in these individuals. Impaired metacognition may therefore represent an important mechanism by which executive dysfunction impacts successful IADL abilities in individuals with MA/HIV. Metacognitive training thus represents a potentially powerful technique to improve IADL functioning in MA/HIV. Metacognitive training is a cognitive rehabilitation technique that teaches individuals to self-regulate and monitor their thoughts and actions in order to gain control over their learning and behaviors. The proposed dissertation project aims to evaluate the efficacy of a brief metacognitive training module for neurocognitive rehabilitation in MA/HIV individuals with executive dysfunction. Due to the current absence of such techniques in this population, results from this study will inform future development of novel behavioral interventions to improve HAND among MA users. Through the implementation of this research project and the comprehensive training plan outlined in this F31 proposal including close interaction with expert mentors in a successful and collaborative research infrastructure (i.e., HIV Neurobehavioral Research Program), the applicant will enhance her scientific knowledge, research design techniques, and ability to further contribute to the fields of IADL functioning and neurocognitive rehabilitation in neuroAIDS and addictions. The opportunities afforded via this F31 mechanism will significantly contribute to the applicant's intermediate goal of attaining a K23 award focused on the development of empirically-based neurorehabilitation techniques and her long-term goal of becoming an independent neurorehabilitation scientist dedicated to improving the lives of persons living with substance use disorders and HIV infection.

Public Health Relevance

Methamphetamine (MA) use is a major risk factor for the transmission of HIV infection, and these two conditions commonly co-occur, resulting in impairments in higher level cognition and problem-solving difficulties in up to 60% of HIV infected MA users (MA/HIV). Despite the established relationship between such problem-solving difficulties and declines in daily functioning (e.g., unemployment and medication nonadherence), there are no empirically validated techniques to address these impairments and their everyday life consequences among MA/HIV persons. This study aims to examine a targeted remediation technique in order to improve quality of life and reduce the economic burden associated with these impairments in persons living with MA/HIV.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1-AARR-C (22))
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Lin, Yu
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University of California San Diego
Schools of Medicine
La Jolla
United States
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Obermeit, Lisa C; Beltran, Jessica; Casaletto, Kaitlin B et al. (2017) Evaluating the accuracy of self-report for the diagnosis of HIV-associated neurocognitive disorder (HAND): defining ""symptomatic"" versus ""asymptomatic"" HAND. J Neurovirol 23:67-78
Flores, Ilse; Casaletto, Kaitlin B; Marquine, Maria J et al. (2017) Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds. Clin Neuropsychol 31:783-797
Sepeta, Leigh N; Casaletto, Kaitlin Blackstone; Terwilliger, Virginia et al. (2017) The role of executive functioning in memory performance in pediatric focal epilepsy. Epilepsia 58:300-310
Casaletto, Kaitlin B; Ward, Michael E; Baker, Nicholas S et al. (2017) Retinal thinning is uniquely associated with medial temporal lobe atrophy in neurologically normal older adults. Neurobiol Aging 51:141-147
Casaletto, Kaitlin B; Umlauf, Anya; Marquine, Maria et al. (2016) Demographically Corrected Normative Standards for the Spanish Language Version of the NIH Toolbox Cognition Battery. J Int Neuropsychol Soc 22:364-74
Casaletto, Kaitlin B; Kwan, Sara; Montoya, Jessica L et al. (2016) Predictors of psychotropic medication adherence among HIV+ individuals living with bipolar disorder. Int J Psychiatry Med 51:69-83
Casaletto, Kaitlin B; Moore, David J; Woods, Steven Paul et al. (2016) Abbreviated Goal Management Training Shows Preliminary Evidence as a Neurorehabilitation Tool for HIV-associated Neurocognitive Disorders among Substance Users. Clin Neuropsychol 30:107-30
Obermeit, Lisa C; Morgan, Erin E; Casaletto, Kaitlin B et al. (2015) Antiretroviral Non-Adherence is Associated With a Retrieval Profile of Deficits in Verbal Episodic Memory. Clin Neuropsychol 29:197-213
Casaletto, K B; Obermeit, L; Morgan, E E et al. (2015) Depression and executive dysfunction contribute to a metamemory deficit among individuals with methamphetamine use disorders. Addict Behav 40:45-50
Moore, David J; Poquette, Amelia; Casaletto, Kaitlin B et al. (2015) Individualized texting for adherence building (iTAB): improving antiretroviral dose timing among HIV-infected persons with co-occurring bipolar disorder. AIDS Behav 19:459-71

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