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Assessing Risk of HIV-Associated Neurocognitive Disorder

Cummins, Denise; Waters, Donna; Aggar, Christina; O’Connor, Catherine C.

doi: 10.1097/NNR.0000000000000312
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Background People with HIV (PLHIV) are aging, and 20% are at risk of developing a neurological complication known as HIV-associated neurocognitive disorder (HAND). Signs and symptoms of HAND may be subtle; however, treatment can improve clinical outcomes.

Objective The aim of the study was to identify and agree on a risk assessment and monitoring process for the regular review of patients at risk of HAND.

Methods Between March and September 2017, 25 experts from four community healthcare services participated in three rounds of a modified Delphi study to reach consensus on the items, monitoring period, and format of assessment tools to identify risk of HAND in PLHIV in the community.

Results More than 80% consensus was reached at all three Delphi rounds. A flow chart, an initial assessment, and an annual monitoring tool were developed for an ongoing assessment of risk of developing HAND.

Conclusion Twenty percent of PLHIV may develop HAND, a treatable condition. The use of a modified Delphi method led to the successful development of two risk assessment tools to identify those at risk of HAND. The initial assessment tool may be used as a precursor to formal assessment by medical and nursing staff, whereas the annual monitoring tool may assist community-based health professionals in their ongoing assessment of risk of HAND in PLHIV, facilitating early formal medical review for this condition.

Denise Cummins, PhD(c), MPH, Grad Cert Onc, RN, is Doctoral Student, Sydney Nursing School, University of Sydney, New South Wales, Australia, and Clinical Nurse Consultant-HIV Disease, Sydney District Nursing, Community Health, Sydney Local Health District, New South Wales, Australia.

Donna Waters, PhD, MPH, BA, RN, is Professor, Primary Supervisor for PhD, and Dean of the Sydney Nursing School, University of Sydney, New South Wales, Australia.

Christina Aggar, PhD, GCHE, BN(Hons), RN, is Senior Lecturer and Secondary Supervisor, School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia.

Catherine C. O’Connor, DrPH, MBBS(Hons), MM, is Director of RPA Sexual Health Service, Community Health, Sydney Local Health District, New South Wales, Australia, and Researcher, The Kirby Institute, University of New South Wales, Sydney, Australia, and Central Clinical School, The University of Sydney, New South Wales, Australia.

Accepted for publication April 27, 2018.

The authors would like to thank Dr. Melissa Corr, Psychiatrist, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, for reviewing documents; each team member who participated as expert panel members in the Delphi study; panel members who participated in this study; and Mr. Michael Smith, HIV Outreach Team, South Eastern Sydney Local Health District, Sydney, Australia, for his ongoing support of this study.

The authors have no conflict of interest to declare.

Corresponding author: Denise Cummins, PhD(c), MPH, Grad Cert Onc, RN, Sydney Nursing School, University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia, and Sydney District Nursing, Redfern Health Centre, 103–105 Redfern Street, Redfern, NSW 2016, Australia (e-mail: denise.cummins@health.nsw.gov.au).

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