Effective self-management, including adherence to medication, physical activity, and diet regimens, is essential to maintaining health and well-being in people living with HIV/AIDS (PLWH). Despite best efforts of providers and patients, self-management adherence is less than optimal, leading to subsequent health complications and poor health outcomes. This study will build on previous findings related to executive functioning in developing greater understanding of influences on self-management, identifying targets for intervention. The cognitive, ?top-down? process of executive functioning is the mechanism by which a person decides to adhere or not adhere to a given self-management task. Executive functioning is comprised of three major components (inhibitory control, working memory, and cognitive flexibility) and individuals with higher levels of executive functioning demonstrate better adherence to some self-management tasks, such as maintaining a healthy diet. Despite some evidence that these components have relationships with self-management adherence tasks (e.g. inhibitory control has the strongest effects on decisions about diet and physical activity), specific effects of each component on specific self-management tasks, particularly in PLWH, have not been comprehensively tested. Symptoms (e.g. fatigue, pain, depression) also demonstrate a negative association with self-management adherence. This association is especially important to PLWH as they have a high (over 50%) incidence of one or more HIV-related symptom, increasing risk for poor self-management adherence/outcomes. Higher levels of symptoms also are associated with poorer executive functioning levels. Together, these findings suggest there are associations among executive functioning, HIV-related symptoms, and self-management in PLWH, though this hypothesis has not been explored. Building on these findings, this supplemental study will explore these important gaps in HIV/AIDS self-management literature. This is a cross-sectional, descriptive supplement to the PROSPER-HIV parent grant.
Aims are to: (1) explore the effect of executive functioning (inhibitory control, working memory, cognitive flexibility) on self- management adherence (global self-management, medication adherence, diet, physical activity); (2) examine HIV-related symptom moderation of the executive function/self-management adherence process. We will recruit 200 participants enrolled in PROSPER-HIV over a two-year period to examine these aims. The supplement will abstract gold-standard measures of diet and physical activity, as well HIV-related symptoms, from the PROSPER-HIV database while adding executive function testing as a new study component. When this study is complete, we will be able to evaluate the impact of executive functioning and HIV-related symptoms on self-management adherence in PLWH. Findings will support future self-management research, including development of targeted interventions in order to improve adherence in PLWH.

Public Health Relevance

Strategies improving self-management adherence among PLWH are urgently needed. To meet this public health need, we are proposing to test negative influence of HIV-related symptoms on the brain-behavior link between executive function and self-management adherence, an essential cognitive process driving self- management decision making. Findings will generate new scientific knowledge in HIV self-management.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
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Henry, Rebecca
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Case Western Reserve University
Schools of Nursing
United States
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Webel, Allison R; Willig, Amanda L; Liu, Wei et al. (2018) Physical Activity Intensity is Associated with Symptom Distress in the CNICS Cohort. AIDS Behav :
Webel, Allison; Prince-Paul, Maryjo; Ganocy, Stephen et al. (2018) Randomized clinical trial of a community navigation intervention to improve well-being in persons living with HIV and other co-morbidities. AIDS Care :1-7