School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Psychology, University of Houston, Houston, TX, USA.
Arch Clin Neuropsychol. 2020 Jul 24;35(5):517-527. doi: 10.1093/arclin/acaa005.
People living with HIV (PLWH) are at higher risk for poorer neurocognitive functioning and health literacy than uninfected persons, which are associated with worse medical outcomes. Aging research suggests that the effect of neurocognitive functioning on health outcomes may be more pronounced in those with low health literacy. We aimed to determine whether low health literacy might amplify the adverse effects of neurocognitive functioning on treatment management outcomes in 171 PLWH aged 40+.
In this cross-sectional, observational study, participants completed a well-validated battery of neurocognitive, health literacy, and treatment management measures. A binary health literacy variable (low vs. adequate) was determined via established cut points on the well-validated health literacy tests. Treatment management outcomes included biomarkers of HIV (i.e., CD4 counts and viral load), self-management of HIV disease (i.e., self-reported medication adherence and self-efficacy for HIV disease management), and performance-based health-related decision-making.
Forty-seven percent of the sample met the criteria for low health literacy. Multivariable regressions adjusting for clinicodemographic (e.g., race, socioeconomic status) covariates revealed significant interactions for self-efficacy for HIV disease management and health-related decision-making, such that neurocognitive functioning was associated with these outcomes among those with low, but not adequate health literacy.
Findings suggest that low health literacy may increase the vulnerability of PLWH to the adverse effects of neurocognitive impairment on health outcomes, or conversely that adequate health literacy may provide a buffer against the health risks associated neurocognitive impairment. Interventions targeting health literacy in PLWH may mitigate the effects of neurocognitive impairment on health outcomes.
感染艾滋病毒（HIV）的人（PLWH）的神经认知功能和健康素养较差的风险更高，这与更差的医疗结果相关。衰老研究表明，神经认知功能对健康结果的影响在健康素养较低的人群中可能更为明显。我们旨在确定在 171 名 40 岁以上的 PLWH 中，低健康素养是否会放大神经认知功能对治疗管理结果的不利影响。
在这项横断面、观察性研究中，参与者完成了一套经过充分验证的神经认知、健康素养和治疗管理措施的测试。通过经过充分验证的健康素养测试的既定临界点确定二元健康素养变量（低与足够）。治疗管理结果包括 HIV 的生物标志物（即 CD4 计数和病毒载量）、HIV 疾病的自我管理（即自我报告的药物依从性和 HIV 疾病管理的自我效能）和基于表现的与健康相关的决策。
样本中有 47%的人符合低健康素养的标准。调整了临床人口统计学（例如，种族、社会经济地位）协变量的多元回归显示，自我效能感对 HIV 疾病管理和与健康相关的决策存在显著的相互作用，即神经认知功能与这些结果在健康素养低的人群中相关，但在健康素养足够的人群中则没有相关性。
研究结果表明，低健康素养可能会增加 PLWH 对神经认知障碍对健康结果的不利影响的脆弱性，或者相反，足够的健康素养可能会为与神经认知障碍相关的健康风险提供缓冲。针对 PLWH 的健康素养干预措施可能会减轻神经认知障碍对健康结果的影响。
