This R21 proposal involves an exploratory study to further develop and evaluate the use of a cognitive intervention, spaced retrieval (SR), to improve HIV therapy adherence in HIV+ older adults. There is some evidence that the incidence of cognitive deficits such as executive dysfunction may be especially high in HIV+ older adults. Given the complexity of HAART regimens, cognitive deficits typically found in HIV+ older adults place them especially at risk for non-adherence to treatment regimens. Neundorfer et al. (2002) found that a combination of external aids such as pill boxes, checklists, calendars, etc. and SR strategy training in the appropriate use of such aids was an effective means of enabling HIV+ older adults to reach and maintain therapeutic goals, including medication adherence, in spite of deficits in executive function. Joltin, Camp, and McMahon, (in press) found that delivering SR over the telephone shows promise as an alternative means of providing SR training to older adults with memory deficits. In the proposed exploratory study, 60 HIV+ older individuals will be trained using a combination of practice with external aids and SR strategy learning to improve their adherence to HIV therapy. Half of these participants will receive SR training in a face-to-face format, the other half over the telephone. Thirty-minute training sessions will be given twice a week for four weeks (8 sessions). It is hypothesized that at least 90% of the participants will be able to learn appropriate strategies enabling them to use external aids related to therapy adherence during this time frame. Assessments of adherence to therapy regimens will be conducted at initial screening of participants, at baseline, and again at 3-month, 6-month, and 9-month intervals after training. Booster SR sessions will be provided if adherence declines. Clinical outcomes (viral load, CD4 count) will be assessed before training and at final posttest. The primary objectives of the project are as follows: Objective 1: To determine if this SR intervention for older adults with HIV can result in their learning strategies related to using external aids for adherence to treatment regimens. Objective 2: To determine if this SR intervention can be delivered effectively over the telephone to H1V+ older adults. Objective 3: To determine if learning to use external aids with this SR intervention is related to successful adherence outcomes in HIV+ older adults. Objective 4: To examine the relationships between adherence outcomes and clinical outcomes, i.e., viral load and CD4 counts.
