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3. Lack of Association of Vascular Risk Factors with HIV-Associated Neurocognitive Disorders in cART-Treated Adults Aged ≥ 50 Years in Tanzania

Author

Flack, Katherine A., primary, Rainey, Emma S., additional, Urasa, Sarah J., additional, Koipapi, Sengua, additional, Kalaria, Rajesh N., additional, Howlett, William P., additional, Mukaetova-Ladinska, Elizabeta B., additional, Dekker, Marieke C. J., additional, Gray, William K., additional, Walker, Richard W., additional, Dotchin, Catherine L., additional, Mtwaile, Himidi, additional, Lewis, Thomas C. D., additional, Stone, Lydia G., additional, McNally, Richard J. Q., additional, Makupa, Philip C., additional, and Paddick, Stella-Maria, additional

Published
2024
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5. Low levels of frailty in HIV-positive older adults on antiretroviral therapy in northern Tanzania

Author

Bristow, Clare, George, Grace, Hillsmith, Grace, Rainey, Emma, Urasa, Sarah, Koipapi, Sengua, Kisoli, Aloyce, Boni, Japhet, Saria, Grace Anderson, Ranasinghe, Sherika, Joseph, Marcella, Gray, William K., Dekker, Marieke, Walker, Richard W., Dotchin, Catherine L., Mukaetova-Ladinska, Elizabeta, Howlett, William, Makupa, Philip, and Paddick, Stella-Maria

Published
2021
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10. HIV-Associated Neurocognitive Disorders: The First Longitudinal Follow-Up of a cART-Treated Cohort of Older People in Sub-Saharan Africa

Author

Spooner, Rebecca, primary, Ranasinghe, Sherika, additional, Urasa, Sarah, additional, Yoseph, Marcella, additional, Koipapi, Sengua, additional, Mukaetova-Ladinska, Elizabeta B., additional, Lewis, Thomas, additional, Howlett, William, additional, Dekker, Marieke, additional, Kisoli, Aloyce, additional, Gray, William K., additional, Walker, Richard W., additional, Dotchin, Catherine L., additional, Kalaria, Raj, additional, Lwezuala, Bingileki, additional, Makupa, Philip C., additional, Akinyemi, Rufus, additional, and Paddick, Stella M., additional

Published
2022
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19. Age and frailty are independently associated with increased covid-19 mortality and increased care needs in survivors: results of an international multi-centre study

Author

Alsahab, Mustafa, Beishon, Lucy, Brown, Bryony, Burn, Elinor, Burton, Jenni K, Cox, Natalie, Dani, Melanie, Elhadi, Muhammed, Freshwater, Sarah, Gaunt, Victoria, Gordon, Adam, Goujon, Marie, Hale, Matthew, Hughes, Terry, Jackson, Thomas A, Jelley, Benjamin, Khan, Asma, Khiroya, Heena, Lal, Rajni, Madden, Katy, Magill, Laura, Masoli, Jane, Masud, Tahir, McCluskey, Lauren, McNeela, Natalie, Mohammedseid-Nurhussien, Awolkhier, Moorey, Hannah, Lochlainn, Mary Ni, Nirantharakumar, Krishnarajah, Okoth, Kelvin, Osuafor, Christopher N, Patterson, Katherine, Pearson, Grace M E, Perry, Rita, Pettitt, Michala, Pigott, Jennifer, Pinkney, Thomas, Quinn, Terence, Reynolds, Abigail, Richardson, Sarah, Sanyal, Nik, Seed, Adam, Sleeman, Isobel, Soo, Chee, Steves, Claire, Strain, W David, Taylor, Joanne, Torsney, Kelli, Welch, Carly, Wilson, Daisy, Witham, Miles, Elazeem, Hossam Aldein S Abd, Abdelhafez, Mohammed H, Abdelmalak, Amir, Abdelwahab, Omar A, Abdulhadi, Osama M A S, Adewole, Olubayode, Ahmad, Mohammed, Ahmed, Eltayeb A, Ahmed, Hazem, Ahmed, Islam A, Akcay, Mertcan, Akdeniz, Yeşim, Akın, Emrah, Akladious, Carolyn, Alessandri, Francesco, Ali, Ali, Aljafari, Abdulmalek, Aljafari, Abdulmoiz, Al-Sadawi, Mohammed, Al-Sodani, Lobna, Altintoprak, Fatih, Amaratungaz, Gitanjali, Amer, Jocelyn, Amini, Sylvia, Amir, Taha, Anandarajah, Cheran, Anders, Rachael, Ansari, Muhammed H, Appiah, Kingsley, Atia, Jolene, Atkin, Catherine, Aujayeb, Avinash, Awad, Elsayed M, Azab, Mohammed A, Azam, Mohammad T, Aziz, Sally, Azzam, Ahmed Y, Babar, Laxmi, Babb, Laura, Badh, Manpreet, Baguneid, Clare, Bailey, Emily, Baili, Efstratia, Baldwin, Sarah, Baloyiannis, Ioannis, Bannerjee, Moulinath, Barnard, Anna, Barra, Fabio, Bashir, Hannah, Bawor, Monica, Bayhan, Zülfü, Belcher, James, Belgamwar, Ravindra, Bentley, Corrina, Birchenough, Amy, Bo, Yen Nee J, Boden, Hayley R, Bouhuwaish, Ahmad, Brachini, Gioia, Bremner, Laura, Bridgwater, Hannah, Bryant, Catherine, Budd, Gabrielle, Budd, Sharon, Budzikoski, Adam, Bulla, Reem, Buondonno, Antonio, Burden, Nicole, Butt, Hejab, Capoglu, Recayi, Caracostea, Andra, Cardoso, Rifa, Carr, Alexis, Carrasco-Prats, Milagros, Cattel, Caterina, Ceccarelli, Giancarlo, Cecere, Giuseppe, Charalabopoulos, Alexandros, Charsley, Evelyn, Cheney-Lowe, Hannah, Chevallier, Theodore, Choudhry, Asad J, Ciccarone, Flavia, Cicerchia, Pierfranco M, Cirillo, Bruno, Collins, Fatma D, Comerford, Victoria, Cordie, Ahmed, Coulter, Siobhan, Coulthard, Nick, Cox, Catrin, Cox, Victoria, Crowe, Andrew, Cullen, Jack, Cummings, Jean, Cunningham, Niamh, Curley, Daniel, Currie, Hannah, Daly, Madeleine, Darley, Jay, Dattani, Nikhita, Davakis, Spyridon, Davies, Rowan, De Paola, Gilda, De Toma, Giorgio, Del Valle-Ruiz, Sergio, Deldar, Benyamin, Demir, Hakan, Desai, Arjun, Desai, Nirali, Devaney, Alice, Dew, Lindsey, Dhesi, Jugdeep, Dias, Maria, Dick, Gordon, Doddamani, Parveen, Dogra, Gurinder, Doll, Tina, Dooley, Hannah C, Dost, Samiullah, Dotchin, Catherine, Dowell, Hannah, Draghita, Ioan M, Dundas, James M, Duranti, Giulia, Dusara, Hiren, Dwivedi, Rajesh, Dyer, Adam H, Eastaugh, Alison, Edwards, Elinor, Elghazaly, Shrouk M, Elmehrath, Ahmed O, Elrick, Hope, El-Shazly, Mostafa, Emery, Alexander, Etchill, Eric W, Evans, Sarah, Evison, Felicity, Fairhead, Cassandra, Faulkner, Margherita, Felska, Agnieszka, Fernandez, Antia, Fernández-Fernández, Pedro V, Ferraiolo, Antonella, Ferrero, Simone, Fiori, Enrico, Firat, Necattin, Fisk, Gracie, Fleck, Anna, Fonsi, Giovanni B, Gabre-Kidan, Alodia, Gallo, Gaetano, Gandhi, Ratnam, Garner, Madeleine, Georgiou, Nikolaos, Gerretsen, Hannah, Ghannam, Nourhan A A, Ghobrial, Andrew, Ghobrial, Hedra, Ghufoor, Zaynub, Gibbon, Jake, Gilbert, Georgia F, Giles, Marie, Giménez-Francés, Clara, Gonullu, Emre, Gray, Amy, Gray, Joshua H, Green, Deirdre, Greene, Charlotte, Griffin, Ellanna, Griffith, Karla, Grubb, Anthony, Guan, Yue, Guerero, Daniel N, Gupta, Ayushi, Gustavino, Claudio, Guzman, Laurenny, Hadreiez, Ahmed K M, Hajiioannou, Jiannis, Hanji, Deevia, Madhavan, Deepthy Hari, Harmantepe, Tarık, Harrison, Patrick, Hart, Barbara, Haslam, Aidan, Haunton, Victoria, Haut, Elliott R, Heinsohn, Torben, Hennah, Lindsay, Hetta, Helal F, Hickman, Alexander, Hobill, Abigail, Hogan, Patrick C P, Hogan, Vesna, Holmes, Elizabeth, Honney, Katie, Hood, Katharine, Hopkinson, Katherine, Howells, Lara, Hrouda, Nicole, Hunsley, Danielle, Hurst, William, Hussein, Rand A, Ibrahim, Mohamed Eltaher A A, Ibtida, Ishmam, Ibukunoluwakitan, Aina, Ishlek, Irem, Iyer, Rishi, Jackson, Karl, Jackson, Rosie, James, Ellen, Jarvis, Hayley, Jeffs, Sophie, Jenko, Nathan, Jeyakumar, Sasha, Kabir, Shahriar, Kainth, Harjinder, Kalloo, Jason, Kanzaria, Akhil, Karapanou, Amalia, Kardaman, Nuha, Karthikeyan, Sandeep, Karunatilleke, Anne, Kelly, Mairead, Kelly, Nicola I, Khalid, Hesham, Khan, Haris, Khan, Muhammad S, King, Matthew, Kneen, Thomas, Kok, Li, Kratochwila, Chiara, Kuzeva, Aneliya, Lapolla, Pierfrancesco, Lau, Rebecca, Law, Kar Yee, Leadbetter, Aimee, Lee, Gabriel, Lee, Helena, Levinson, Gavriella, Lewis, Grace, Liakakos, Theodore, Lim, Stephen, Lis, Danielle, Livesey, Emma, López-Morales, Pedro, Lowes, Lily, Lunt, Eleanor, Lyon, Emily, Madan, Suvira, Majid, Zeinab, Malapati, Harsha, Man, Jade, Mandane, Baguiasri, Manning, Sarah H, Mantoglu, Baris, Martínez-Sanz, Nuria, Marx, William, Masood, Almontacer E B, Maughan, Tom, Mawhinney, Jamie, Maxfield, Dominic, Mayer, Jordan, Maynard, Henry, McDonald, Claire, McGovern, Aine, Mclachlan, Sophie, Medina-Manuel, Esther, Meneghini, Simona, Metcalf, Michelle, Millwood-Hargrave, John, Mingoli, Andrea, Miu, Kelvin, Mohamed, Fawsiya, Mohamed, Soha M, Hussein, Aliae A R Mohamed, Mohammad, Abdulkader, Mohammed, Aaliya, Momen, Ahmed A, Moomo, Farhana, Mora-Guzmán, Ismael, Moriarty, Lizzie, Morrin, Hamilton, Morris, Claire, Moss, Nicholas, Moustafa, Mohamed M, Mpoura, Maria, Mubin, Mohammed, Muhtaroglu, Ali, Muir, Georgina, Mulhern, Stephanie, Muller, Daniel, Murphy, Declan C, Muzammil, Bushra, Nadkarni, Varun, Nageh, Mariam Albatoul, NasrEldin, Yasmin K, Nawaz, Wasim, Nguyen, Hanna, Cheallaigh, Cliona Ni, Noar, Alexander, North, Samuel, Nwolu, Favour, O’Docherty, Alice, Odutola, Omoteniola, O’Dwyer, Sinead, Ogochukwu, Olebu, O’Mahony, Catherine, Orlando, Lia, Osterdahl, Marc, Page, Christina, Panayotidis, Ismini, Pancholi, Shivam, Parkin, Jessica, Passby, Lauren C, Pastor-Pérez, Patricia, Patel, Harnish, Patel, Shefali, Penfold, Rose, Perinpanathan, Rupini, Perivoliotis, Konstantinos, Perra, Teresa, Pinkney, Martha, Pinotti, Enrico, Porcu, Alberto, Price, Angeline, Pugliese, Francesco, Puri, Prabhleen, Pytraczyk, Sylvia, Qaiser, Yusra, Qurashi, Maria, Radenkovic, Dina, Rajeswaran, Thurkka, Rapaport, Sarah F, Razzak, Tahmina, Reilly, Lara, Reynolds, Paul, Richardson, Alexandra, Roberts, Amelia, Roberts-Rhodes, Charlotte, Robinson, Tanya, Rocca, Aldo, Ross-Skinner, Emily, Ruiz-Marín, Miguel, Ryall, Rebecca, Saad, Alshaimaa M, Saad, Mahmoud M, Sadiq, Ambreen, Sammarco, Giuseppe, Sampanis, Michail A, Sanghvi, Hazel, Sapienza, Paolo, Sayers, Ross, Scott, Luca, Sen, Michael, Shaban, Mosab A A, Shakespeare, Kathleen T, Shaw, Ellie, Shaw, Hannah, Sheldrake, Jonathan, Sim, Sing Yang, Simonelli, Luigi, Sipsas, Nikolaos V, Sivam, Jarita, Sivarajan, Sri, Smith, Jennifer, Speranza, Fabio, Spice, Claire, Stafford, Amanda, Stambollouian, Katharine, Stevens, Kent A, Stewart, Jack, Stratton, Emma, Street, Hannah, Surtees, Michael, Swinnerton, Emma, Taher, Ahmed S A, Tait, Caroline, Taylor, Amybel, Thake, Miriam, Thin, Katie, Thould, Hannah, Thyn, Thyn, To, Benjaman, Tobiss, Hannah, Toppley, Kathryn, Townsend, Liam, Tullo, Ellen, Tzovaras, George, Umeadi, Anthony, Vaidya, Hrisheekesh, Valero-Soriano, María, Varden, Rosanna, Vergani, Vittoria, Vervoort, Dominique, Vescio, Giuseppina, Vettasseri, Mark, Virk, Madiha, Vyas, Vaishali, Wagland, Joanne, Wallis, Stephanie, Warner, Chloe, Watkins, Eleanor, Watson, Hannah, Webb, Rachael, Welsh, Sarah H, West, Ruth, Whelan, Elisha, Whitney, Julie, Whitsey, Mark, Wilcock, Catherine, Wilkinson, Iain, Williams, David, Williamson, Megan, Willott, Ruth H, Wimalasundera, Mettha, Win, Yu Lelt, Winter, Laura, Worrall, Stephanie, Wright, Rebecca, Yeo, Natalie, Yeung, Eirene, Yigit, Merve, Yildiz, Yasin A, Yusuf, Humza, Zambon, Martina, Zaw, Hein, and Elabedeen, Omar Zein

Subjects
Male, Aging, medicine.medical_specialty, Frail Elderly, COVID-19, delirium, frailty, mortality, transitions of care, Cohort Studies, AcademicSubjects/MED00280, Interquartile range, Internal medicine, medicine, Dementia, Humans, Survivors, Aged, Proportional hazards model, business.industry, SARS-CoV-2, Hazard ratio, Odds ratio, General Medicine, medicine.disease, Confidence interval, frailty,COVID-19, Ageing, Delirium, Female, medicine.symptom, Geriatrics and Gerontology, business, Cohort study, Research Paper
Abstract

Introduction Increased mortality has been demonstrated in older adults with coronavirus disease 2019 (COVID-19), but the effect of frailty has been unclear. Methods This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS) and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Results Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, interquartile range [IQR] 54–83; 55.2% male). The risk of death increased independently with increasing age (>80 versus 18–49: hazard ratio [HR] 3.57, confidence interval [CI] 2.54–5.02), frailty (CFS 8 versus 1–3: HR 3.03, CI 2.29–4.00) inflammation, renal disease, cardiovascular disease and cancer, but not delirium. Age, frailty (CFS 7 versus 1–3: odds ratio 7.00, CI 5.27–9.32), delirium, dementia and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. Conclusion Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.

Published
2021

21. Population normative data for three cognitive screening tools for older adults in sub-Saharan Africa

Author

Gray, William Keith, primary, Paddick, Stella-Maria, additional, Ogunniyi, Adesola, additional, Olakehinde, Olaide, additional, Dotchin, Catherine, additional, Kissima, John, additional, Urasa, Sarah, additional, Kisoli, Aloyce, additional, Rogathi, Jane, additional, Mushi, Declare, additional, Adebiyi, Akindele, additional, Haule, Irene, additional, Robinson, Louise, additional, and Walker, Richard, additional

Published
2021
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23. The experience of Parkinson's disease in Hai District, Tanzania

Author

Dotchin Catherine, Kisima John, Fothergill-Misbah Natasha, Walker Richard, and Hampshire Kate

Subjects
Tanzania, Parkinson's disease, biology, business.industry, Environmental health, Medicine, business, biology.organism_classification, medicine.disease
Abstract

Background: Parkinson's disease (PD) is a debilitating neurological disease that can result in a reduced quality of life for people with Parkinson's disease (PwP) and their families. The incidence of PD continues to increase as the global population ages, as is being experienced in Tanzania and much of sub-Saharan Africa, yet healthcare systems are under-developed and not prepared to manage the burden posed by chronic conditions. Little is known about people's experiences of long-term drug treatment for PD and the impact disease progression has on PwP and their families' lives. This paper outlines findings from a small-scale qualitative research study on the experiences of PwP in later stages of illness and their families in the Hai district of Tanzania.Methods: semi-structured biographical in-depth interviews were conducted with three PwP and six caregivers in the Hai district of Tanzania. Interviews explored participants' experiences of living with PD and caring for a family member with PD, their response to biomedical treatment, use of alternative treatment practices and understanding about the disease.Results: PWP and caregivers all expressed the emotional, social, physical and economic strain of PD. PwP felt angry and frustrated with their deteriorating condition and increasing dependence but pleased with the treatment. Caregivers described the full-on nature of their caring role which resulted in increasing social isolation, worry and stress as the PwPs' condition progressed. Religion, faith and prayers played a significant role in disease management in combination with pharmaceutical treatment. Participants did not report any stigmatisation towards PwP from communities.Conclusion: this study outlines the emotional, financial and physical challenges that PwP at advanced disease stages and their caregivers experienced in the Hai district. It highlights the need for PD management to acknowledge the role of spiritual healing and social support in combination with biomedical treatment to achieve effective care and improve the wellbeing of PwP and their families, and the need for increased awareness and understanding about PD in the region.

Published
2021

30. Mixed methods implementation research of cognitive stimulation therapy (CST) for dementia in low and middle-income countries: study protocol for Brazil, India and Tanzania (CST-International)

Author

Spector, Aimee, primary, Stoner, Charlotte R, additional, Chandra, Mina, additional, Vaitheswaran, Sridhar, additional, Du, Bharath, additional, Comas-Herrera, Adelina, additional, Dotchin, Catherine, additional, Ferri, Cleusa, additional, Knapp, Martin, additional, Krishna, Murali, additional, Laks, Jerson, additional, Michie, Susan, additional, Mograbi, Daniel C, additional, Orrell, Martin William, additional, Paddick, Stella-Maria, additional, KS, Shaji, additional, Rangawsamy, Thara, additional, and Walker, Richard, additional

Published
2019
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31. 'We call it the shaking illness': perceptions and experiences of Parkinson's disease in rural northern Tanzania

Author

Dotchin Catherine L, Mshana Gerry, and Walker Richard W

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Parkinson disease (PD) causes physical disability that negatively affects the quality of life of the sufferer's and their families. There are no Parkinson's disease (PD) social science studies published from Africa. This paper presents findings from a qualitative research study on how PD is perceived and treated in a population of approximately 161,000 within a demographic surveillance site in rural Tanzania. Methods We conducted in-depth interviews with 28 PD sufferers, 28 carers, 4 health workers and 2 traditional healers. In addition, 6 focus group discussions were conducted in 3 villages to investigate wider community views of PD. Results PD sufferers expressed frustration with the physical, psychological, social and economic consequences of the illness. Feelings of a diminished quality of life characterised by dependency, stigma and social isolation were common. Additionally, a handful of male sufferers related their sexual incompetence to the illness. Carers complained of lost income opportunities and social isolation resulting from caring for sufferers. Misconceptions about the cause, symptoms and appropriated PD treatment were widespread. Only 2 PD sufferers had commenced western type treatment through outsourcing drugs from other parts of the country and outside of Tanzania. Conclusions This study highlights the urgent need for PD awareness and treatment interventions in such settings. Such interventions need to address the concerns and needs of sufferers, their carers and the wider community, including the health care system.

Published
2011
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32. Rationing care by frailty during the COVID-19 pandemic.

Author

Lewis, Emma Grace, Breckons, Matthew, Lee, Richard P, Dotchin, Catherine, and Walker, Richard

Subjects
ELDER care, DECISION making, FRAIL elderly, HEALTH care rationing, MEDICAL emergencies, MEDICAL protocols, COMORBIDITY, SOCIOECONOMIC factors, COVID-19 pandemic
Abstract

The coronavirus disease 2019 (COVID-19) pandemic is disproportionately affecting older people and those with underlying comorbidities. Guidelines are needed to help clinicians make decisions regarding appropriate use of limited NHS critical care resources. In response to the pandemic, the National Institute for Health and Care Excellence published guidance that employs the Clinical Frailty Scale (CFS) in a decision-making flowchart to assist clinicians in assessing older individuals' suitability for critical care. This commentary raises some important limitations to this use of the CFS and cautions against the potential for unintended impacts. The COVID-19 pandemic has allowed the widespread implementation of the CFS with limited training or expert oversight. The CFS is primarily being used to assess older individuals' risk of adverse outcome in critical care, and to ration access to care on this basis. While some form of resource allocation strategy is necessary for emergencies, the implementation of this guideline in the absence of significant pressure on resources may reduce the likelihood of older people with frailty, who wish to be considered for critical care, being appropriately considered, and has the potential to reinforce the socio-economic gradient in health. Our incomplete understanding of this novel disease means that there is a need for research investigating the short-term predictive abilities of the CFS on critical care outcomes in COVID-19. Additionally, a review of the impact of stratifying older people by CFS score as a rationing strategy is necessary in order to assess its acceptability to older people as well as its potential for disparate impacts. [ABSTRACT FROM AUTHOR]

Published
2021
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33. The role of traditional and faith healers in the treatment of dementia in Tanzania and the potential for collaboration with allopathic healthcare services: Table 1.

Author

Hindley, Guy, primary, Kissima, John, additional, L. Oates, Lloyd, additional, Paddick, Stella-Maria, additional, Kisoli, Aloyce, additional, Brandsma, Christine, additional, K. Gray, William, additional, Walker, Richard W., additional, Mushi, Declare, additional, and Dotchin, Catherine L., additional

Published
2016
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35. Validation of the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screen in Nigeria and Tanzania

Author

Paddick, Stella-Maria, primary, Gray, William K, additional, Ogunjimi, Luqman, additional, lwezuala, Bingileki, additional, Olakehinde, Olaide, additional, Kisoli, Aloyce, additional, Kissima, John, additional, Mbowe, Godfrey, additional, Mkenda, Sarah, additional, Dotchin, Catherine L, additional, Walker, Richard W, additional, Mushi, Declare, additional, Collingwood, Cecilia, additional, and Ogunniyi, Adesola, additional

Published
2015
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36. Development and community-based validation of the IDEA study Instrumental Activities of Daily Living (IDEA-IADL) questionnaire

Author

Collingwood, Cecilia, primary, Paddick, Stella-Maria, additional, Kisoli, Aloyce, additional, Dotchin, Catherine L., additional, Gray, William K., additional, Mbowe, Godfrey, additional, Mkenda, Sarah, additional, Urasa, Sarah, additional, Mushi, Declare, additional, Chaote, Paul, additional, and Walker, Richard W., additional

Published
2014
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45. Mixed methods implementation research of cognitive stimulation therapy (CST) for dementia in low and middle-income countries: study protocol for Brazil, India and Tanzania (CST-International): study protocol for Brazil, India and Tanzania (CST-International)

Author

Spector, Aimee, Stoner, Charlotte R, Chandra, Mina, Vaitheswaran, Sridhar, Du, Bharath, Comas-Herrera, Adelina, Dotchin, Catherine, Ferri, Cleusa, Knapp, Martin, Krishna, Murali, Laks, Jerson, Michie, Susan, Mograbi, Daniel C, Orrell, Martin, Paddick, Stella-Maria, KS, Shaji, Rangawsamy, Thara, Walker, Richard, Spector, Aimee, Stoner, Charlotte R, Chandra, Mina, Vaitheswaran, Sridhar, Du, Bharath, Comas-Herrera, Adelina, Dotchin, Catherine, Ferri, Cleusa, Knapp, Martin, Krishna, Murali, Laks, Jerson, Michie, Susan, Mograbi, Daniel C, Orrell, Martin, Paddick, Stella-Maria, KS, Shaji, Rangawsamy, Thara, and Walker, Richard

Abstract

Introduction In low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in high-income countries (HICs). Cognitive stimulation therapy (CST) is a group-based, brief, non-pharmacological intervention for people with dementia that significantly improves cognition and quality of life in clinical trials and is cost-effective in HIC. However, its implementation in other countries is less researched. This protocol describes CST-International; an implementation research study of CST. The aim of this research is to develop, test, refine and disseminate implementation strategies for CST for people with mild to moderate dementia in three LMICs: Brazil (upper middle-income), India (lower middle-income) and Tanzania (low-income). Methods and analysis Four overlapping phases: (1) exploration of barriers to implementation in each country using meetings with stakeholders, including clinicians, policymakers, people with dementia and their families; (2) development of implementation plans for each country; (3) evaluation of implementation plans using a study of CST in each country (n=50, total n=150). Outcomes will include adherence, attendance, acceptability and attrition, agreed parameters of success, outcomes (cognition, quality of life, activities of daily living) and cost/affordability; (4) refinement and dissemination of implementation strategies, enabling ongoing pathways to practice which address barriers and facilitators to implementation. Ethics and dissemination Ethical approval has been granted for each country. There are no documented adverse effects associated with CST and data held will be in accordance with relevant legislation. Train the trainer models will be developed to increase CST provision in each country and policymakers/governmental bodies will be continually engaged with to aid successful imple

46. HIV-Associated Neurocognitive Disorders: The First Longitudinal Follow-Up of a cART-Treated Cohort of Older People in Sub-Saharan Africa.

Author

Spooner R, Ranasinghe S, Urasa S, Yoseph M, Koipapi S, Mukaetova-Ladinska EB, Lewis T, Howlett W, Dekker M, Kisoli A, Gray WK, Walker RW, Dotchin CL, Kalaria R, Lwezuala B, Makupa PC, Akinyemi R, and Paddick SM

Subjects
Aged, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Neurocognitive Disorders complications, Neurocognitive Disorders epidemiology, Tanzania, AIDS Dementia Complex complications, AIDS Dementia Complex drug therapy, AIDS Dementia Complex epidemiology, HIV Infections complications, HIV Infections drug therapy, HIV Infections epidemiology
Abstract

Background: HIV-associated neurocognitive disorders (HAND) are a highly prevalent chronic complication in older people living with HIV (PLWH) in high-income countries. Although sub-Saharan Africa has a newly emergent population of older combination antiretroviral therapy (cART)-treated PLWH, HAND have not been studied longitudinally. We assessed longitudinal prevalence of HAND and have identified possible modifiable factors in a population of PLWH aged 50 years or older, over 3 years of follow-up., Methods: Detailed neuropsychological and clinical assessment was completed annually in the period 2016-2019 in a systematic sample of cART-treated PLWH in Kilimanjaro, Tanzania. A consensus panel defined HAND using American Academy of Neurology criteria for asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia. HIV disease severity and other factors associated with HAND progression, improvement, and stability were evaluated in individuals fully assessed at baseline and in 2019., Results: At baseline, 47% of the cohort (n = 253, 72.3% female individuals) met HAND criteria despite good HIV disease control [Y1 59.5% (n = 185), Y2 61.7% (n = 162), and Y3 57.9% (n = 121)]. Of participants fully assessed at baseline and year 3 (n = 121), HAND remained stable in 54% (n = 57), improved in 15% (n = 16), and declined in 31% (n = 33). Older age and lower education level significantly predicted HAND progression, whereas HIV-specific factors did not. Male sex and shorter cART duration were associated with improvement., Conclusions: In this first longitudinal study characterizing clinical course of HAND in older cART-treated PLWH in sub-Saharan Africa, HAND was highly prevalent with variable progression and reversibility. Progression may be more related to cognitive reserve than HIV disease in cART-treated PLWH., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2022
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