Neurocognitive Impairment for Persons Living with HIV in Peru: A National Physician Survey
Rebecca Slotkin1, Hanalise Huff2, Camila Lucero Granda Calderon3, Diego Cabera4, Monica Diaz5, Carlos Manuel Benites Villafane6, Evelyn Hsieh1, Patricia J. Garcia3
1Yale University School of Public Health and School of Medicine, 2National Institute of Health, 3Epidemiology, STD, and HIV Unit, School of Public Health, Universidad Peruana Cayetano Heredia, 4Department of Medicine, Yale University School of Medicine, 5University of North Carolina at Chapel Hill, 6Ministerio de Salud
Objective:
To describe HIV provider screening and management practices for neurocognitive impairment (NCI) in persons living with HIV (PLWH) in Peru.
Background:
As PLWH on antiretrovirals achieve longer lifespans, they experience an increased risk of non-communicable diseases, in particular NCI. In Peru, 28.5% of PLWH > 40 years old were found to have NCI (Diaz 2021). However, there is no data on Peruvian HIV provider management of NCI.
Design/Methods:
Public sector physicians affiliated with Peru’s National HIV, STI and Hepatitis Program were identified by the Program’s provider registry and through regional Program coordinator referral. Willing participants completed a telephone survey, which included: (1) socio-demographics (2) comfort level addressing NCI prevention, diagnosis, and treatment (4-point Likert scale: no certainty, little certainty, certain, very certain), (3) NCI screening frequency, and (4) NCI practice patterns (free response).
Results:
Seventy-eight of 167 identified physicians completed the survey (mean age 45.8±9.3; 26% women; 61% from coastal regions, 18% highlands, 21% jungle; 78% infectious disease specialists). The majority reported lack of comfort (‘no certainty’ or ‘little certainty’) with NCI prevention (59%), diagnosis (53%), and treatment (76%). Comfort level was not associated with any provider sociodemographic characteristics. Sixty-seven percent (52/78) attempted NCI management, 31% (24/78) solely referred to a specialist, and 3% (2/78) did not manage NCI. Management strategies described included: evaluating for contributing opportunistic infections, substance use, or medications (36%), ordering neuroimaging (18%), re-evaluating antiretroviral regimen (17%), performing cognitive assessments (17%), and ruling-out depression (6%). Of physicians who reported at least one of these management strategies, 98% also referred to neurology, psychology, neuropsychology, or geriatrics.
Conclusions:
Although the majority of physicians reported lack of comfort managing NCI in PLWH, most still engaged in some form of NCI management. There is a need to develop training programs, screening tools, and guidelines to standardize the approach to NCI in PLWH in Peru.