Pilot Award

HIV treatment can improve health and longevity and prevent transmission to sexual and injection drug contacts of persons with HIV. However, realizing the benefits of treatment requires consistent engagement in clinical care and adherence to anti-retroviral medication. Both HIV infection and aging are associated with neurocognitive decline. There may also be synergistic effects between HIV infection and aging that accelerate declines in cognitive function. Cognitive impairment may limit individuals? ability to engage in care, particularly in populations where co-morbidities are common. Regardless of any acceleration of cognitive declines, both the HIV infected and jail populations are aging. Thus cognitive impairment in this population may become a more important determinant of engagement in care in the community following release from jail. We propose to study the role of cognitive impairment in the context of an existing randomized trial of patient navigation to promote engagement in care for recently released jail detainees with HIV. Over the course of the one-year follow up period, we will assess cognitive impairment using the Montreal Cognitive Assessment. We will characterize the proportion of individuals with cognitive impairment by age, and examine the effect of cognitive impairment on engagement in care for those randomized to either standard or enhanced case management conditions following release. Results from this work will lead to a better understanding of age and HIV-associated cognitive decline in the jail population and inform frameworks for and targeting of future interventions to promote engagement in care. We hypothesize that at comparable ages, cognitive impairment will be more prevalent in detainees with HIV infected than among those not infected, that those with more severe cognitive impairment will be less able to engage in HIV care, and that the effect of patient navigation will be stronger for those with cognitive impairment than those with normal mental function.