Neurocognitive Impairment for Persons Living with HIV in Peru: A National Physician Survey (P4-8.003)

Abstract

<h3>Objective:</h3> To describe HIV provider screening and management practices for neurocognitive impairment (NCI) in persons living with HIV (PLWH) in Peru. <h3>Background:</h3> 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 &gt; 40 years old were found to have NCI (Diaz 2021). However, there is no data on Peruvian HIV provider management of NCI. <h3>Design/Methods:</h3> 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) <i>socio-demographics</i> (2) <i>comfort level</i> addressing NCI prevention, diagnosis, and treatment (4-point Likert scale: no certainty, little certainty, certain, very certain), (3) <i>NCI screening frequency</i>, and (4) <i>NCI practice patterns</i> (free response). <h3>Results:</h3> 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. <h3>Conclusions:</h3> 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. <b>Disclosure:</b> Dr. Slotkin has received research support from Fogarty International Center, NIH. Dr. Slotkin has received research support from Yale University/NIH. Dr. Huff has nothing to disclose. Dr. Granda has nothing to disclose. Dr. Cabrera has nothing to disclose. Dr. Diaz has nothing to disclose. Dr. Benites has nothing to disclose. Dr. Hsieh has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for American College of Rheumatology. The institution of Dr. Hsieh has received research support from NIH. The institution of Dr. Hsieh has received research support from China Medical Board. The institution of Dr. Hsieh has received research support from Yale Institute for Global Health. The institution of Prof. Garcia has received research support from CDC. The institution of Prof. Garcia has received research support from USAID. The institution of Prof. Garcia has received research support from Interamerican Bank of Development.